|
INSERT IV UMBRELLA
|
Facility
|
IP
|
$4,450.00
|
|
| Hospital Charge Code |
2400335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,214.85 |
| Max. Negotiated Rate |
$4,227.50 |
| Rate for Payer: Cash Price |
$2,670.00
|
| Rate for Payer: Cigna Commercial |
$3,782.50
|
| Rate for Payer: First Health Commercial |
$4,005.00
|
| Rate for Payer: First Health Workers Compensation |
$1,718.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,005.00
|
| Rate for Payer: GEHA Commercial |
$3,115.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,005.00
|
| Rate for Payer: Multiplan All |
$4,049.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,115.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,005.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,227.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,138.50
|
| Rate for Payer: Zelis Auto |
$1,780.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,214.85
|
|
|
INSERT IV UMBRELLA
|
Facility
|
OP
|
$4,450.00
|
|
| Hospital Charge Code |
2400335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,112.50 |
| Max. Negotiated Rate |
$4,227.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,670.00
|
| Rate for Payer: Cash Price |
$2,670.00
|
| Rate for Payer: Cigna Commercial |
$3,782.50
|
| Rate for Payer: First Health Commercial |
$4,005.00
|
| Rate for Payer: First Health Workers Compensation |
$1,718.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,005.00
|
| Rate for Payer: GEHA Commercial |
$3,560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,005.00
|
| Rate for Payer: Humana ChoiceCare |
$1,157.00
|
| Rate for Payer: Multiplan All |
$4,049.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,670.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,115.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,005.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,227.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,337.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,916.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,138.50
|
| Rate for Payer: Zelis Auto |
$1,780.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,214.85
|
|
|
INSERT MULTI-COMP PENIS PROS
|
Facility
|
IP
|
$1,666.00
|
|
|
Service Code
|
CPT 54405
|
| Hospital Charge Code |
6154405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.82 |
| Max. Negotiated Rate |
$1,582.70 |
| Rate for Payer: Cash Price |
$999.60
|
| Rate for Payer: Cigna Commercial |
$1,416.10
|
| Rate for Payer: First Health Commercial |
$1,499.40
|
| Rate for Payer: First Health Workers Compensation |
$643.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,499.40
|
| Rate for Payer: GEHA Commercial |
$1,166.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,499.40
|
| Rate for Payer: Multiplan All |
$1,516.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,166.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,499.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,582.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,249.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,549.38
|
| Rate for Payer: Zelis Auto |
$666.40
|
| Rate for Payer: Zelis Worker's Compensation |
$454.82
|
|
|
INSERT MULTI-COMP PENIS PROS
|
Facility
|
OP
|
$1,666.00
|
|
|
Service Code
|
CPT 54405
|
| Hospital Charge Code |
6154405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$38,225.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$999.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,112.87
|
| Rate for Payer: Cash Price |
$999.60
|
| Rate for Payer: Cash Price |
$999.60
|
| Rate for Payer: Cigna Commercial |
$1,416.10
|
| Rate for Payer: First Health Commercial |
$1,499.40
|
| Rate for Payer: First Health Workers Compensation |
$643.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,499.40
|
| Rate for Payer: GEHA Commercial |
$1,332.80
|
| Rate for Payer: GEHA Medicare |
$19,112.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,499.40
|
| Rate for Payer: Humana ChoiceCare |
$21,024.16
|
| Rate for Payer: Humana Medicare Advantage |
$19,112.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,109.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,112.87
|
| Rate for Payer: Multiplan All |
$1,516.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32,491.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,166.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,499.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,112.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,582.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38,225.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,249.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18,730.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$416.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,112.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,549.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,112.87
|
| Rate for Payer: Zelis Auto |
$666.40
|
| Rate for Payer: Zelis Medicare |
$16,245.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22,935.44
|
| Rate for Payer: Zelis Worker's Compensation |
$454.82
|
|
|
INSERT NASAL SEPTAL BUTTON
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 30220
|
| Hospital Charge Code |
6130220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
INSERT NASAL SEPTAL BUTTON
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 30220
|
| Hospital Charge Code |
6130220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$304.80
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
INSERT NEEDLE CATH BOWEL
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
6144015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
INSERT NEEDLE CATH BOWEL
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
6144015
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Humana ChoiceCare |
$118.30
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$273.00
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$400.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$113.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$227.50
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
6136555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$259.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
6136555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$894.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$315.35
|
| Rate for Payer: First Health Commercial |
$333.90
|
| Rate for Payer: First Health Workers Compensation |
$143.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.90
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| 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 |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$259.70
|
| Rate for Payer: One Health Plan PPO/POS |
$333.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,053.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$148.40
|
| 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 |
$101.28
|
|
|
INSERT PICVAD CATH
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
6136570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.01 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: First Health Workers Compensation |
$407.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$738.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Worker's Compensation |
$288.01
|
|
|
INSERT PICVAD CATH
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
6136570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.01 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,029.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$896.75
|
| Rate for Payer: First Health Commercial |
$949.50
|
| Rate for Payer: First Health Workers Compensation |
$407.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$949.50
|
| Rate for Payer: GEHA Commercial |
$844.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| 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 |
$2,070.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$738.50
|
| Rate for Payer: One Health Plan PPO/POS |
$949.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,390.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,070.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$422.00
|
| 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 |
$288.01
|
|
|
INSERT PROST URETHRAL STENT
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 53855
|
| Hospital Charge Code |
6153855
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.53 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$222.70
|
| Rate for Payer: First Health Commercial |
$235.80
|
| Rate for Payer: First Health Workers Compensation |
$101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$235.80
|
| Rate for Payer: GEHA Commercial |
$183.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$235.80
|
| Rate for Payer: Multiplan All |
$238.42
|
| Rate for Payer: OMNI Networks Commercial |
$183.40
|
| Rate for Payer: One Health Plan PPO/POS |
$235.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$248.90
|
| Rate for Payer: Three Rivers Provider Network All |
$196.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$243.66
|
| Rate for Payer: Zelis Auto |
$104.80
|
| Rate for Payer: Zelis Worker's Compensation |
$71.53
|
|
|
INSERT PROST URETHRAL STENT
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 53855
|
| Hospital Charge Code |
6153855
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.53 |
| Max. Negotiated Rate |
$3,890.28 |
| 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 |
$157.20
|
| 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 |
$1,945.14
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cash Price |
$157.20
|
| Rate for Payer: Cigna Commercial |
$222.70
|
| Rate for Payer: First Health Commercial |
$235.80
|
| Rate for Payer: First Health Workers Compensation |
$101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$235.80
|
| Rate for Payer: GEHA Commercial |
$209.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$235.80
|
| 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 |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$238.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$183.40
|
| Rate for Payer: One Health Plan PPO/POS |
$235.80
|
| 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 |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$248.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$196.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$243.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$104.80
|
| 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 |
$71.53
|
|
|
INSERT PULSE GEN SNGL LEAD
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 33212
|
| Hospital Charge Code |
6133212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$611.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
INSERT PULSE GEN SNGL LEAD
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT 33212
|
| Hospital Charge Code |
6133212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$15,716.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,924.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$524.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,924.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,862.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,858.37
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$699.20
|
| Rate for Payer: GEHA Medicare |
$7,858.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Humana ChoiceCare |
$8,644.21
|
| Rate for Payer: Humana Medicare Advantage |
$7,858.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13,202.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,022.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,858.37
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,359.23
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9,262.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,022.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,858.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15,716.74
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,701.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,022.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,858.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,858.37
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Medicare |
$6,679.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,430.04
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
INSERT SELF-CONTD PROSTHESIS
|
Facility
|
IP
|
$1,342.00
|
|
|
Service Code
|
CPT 54401
|
| Hospital Charge Code |
6154401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.37 |
| Max. Negotiated Rate |
$1,274.90 |
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$1,140.70
|
| Rate for Payer: First Health Commercial |
$1,207.80
|
| Rate for Payer: First Health Workers Compensation |
$518.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.80
|
| Rate for Payer: GEHA Commercial |
$939.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.80
|
| Rate for Payer: Multiplan All |
$1,221.22
|
| Rate for Payer: OMNI Networks Commercial |
$939.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.06
|
| Rate for Payer: Zelis Auto |
$536.80
|
| Rate for Payer: Zelis Worker's Compensation |
$366.37
|
|
|
INSERT SELF-CONTD PROSTHESIS
|
Facility
|
OP
|
$1,342.00
|
|
|
Service Code
|
CPT 54401
|
| Hospital Charge Code |
6154401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.50 |
| Max. Negotiated Rate |
$38,225.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$805.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,112.87
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$1,140.70
|
| Rate for Payer: First Health Commercial |
$1,207.80
|
| Rate for Payer: First Health Workers Compensation |
$518.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.80
|
| Rate for Payer: GEHA Commercial |
$1,073.60
|
| Rate for Payer: GEHA Medicare |
$19,112.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.80
|
| Rate for Payer: Humana ChoiceCare |
$21,024.16
|
| Rate for Payer: Humana Medicare Advantage |
$19,112.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,109.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,112.87
|
| Rate for Payer: Multiplan All |
$1,221.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32,491.88
|
| Rate for Payer: OMNI Networks Commercial |
$939.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,112.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,274.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38,225.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18,730.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$335.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,112.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,112.87
|
| Rate for Payer: Zelis Auto |
$536.80
|
| Rate for Payer: Zelis Medicare |
$16,245.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22,935.44
|
| Rate for Payer: Zelis Worker's Compensation |
$366.37
|
|
|
INSERT SEMI-RIGID PROSTHESIS
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 54400
|
| Hospital Charge Code |
6154400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$24,673.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$653.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,336.82
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna Commercial |
$925.65
|
| Rate for Payer: First Health Commercial |
$980.10
|
| Rate for Payer: First Health Workers Compensation |
$420.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$980.10
|
| Rate for Payer: GEHA Commercial |
$871.20
|
| Rate for Payer: GEHA Medicare |
$12,336.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$980.10
|
| Rate for Payer: Humana ChoiceCare |
$13,570.50
|
| Rate for Payer: Humana Medicare Advantage |
$12,336.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,725.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,336.82
|
| Rate for Payer: Multiplan All |
$990.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,972.59
|
| Rate for Payer: OMNI Networks Commercial |
$762.30
|
| Rate for Payer: One Health Plan PPO/POS |
$980.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,336.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,034.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,673.64
|
| Rate for Payer: Three Rivers Provider Network All |
$816.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,090.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$272.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,336.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,012.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,336.82
|
| Rate for Payer: Zelis Auto |
$435.60
|
| Rate for Payer: Zelis Medicare |
$10,486.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,804.18
|
| Rate for Payer: Zelis Worker's Compensation |
$297.30
|
|
|
INSERT SEMI-RIGID PROSTHESIS
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 54400
|
| Hospital Charge Code |
6154400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.30 |
| Max. Negotiated Rate |
$1,034.55 |
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna Commercial |
$925.65
|
| Rate for Payer: First Health Commercial |
$980.10
|
| Rate for Payer: First Health Workers Compensation |
$420.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$980.10
|
| Rate for Payer: GEHA Commercial |
$762.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$980.10
|
| Rate for Payer: Multiplan All |
$990.99
|
| Rate for Payer: OMNI Networks Commercial |
$762.30
|
| Rate for Payer: One Health Plan PPO/POS |
$980.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,034.55
|
| Rate for Payer: Three Rivers Provider Network All |
$816.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,012.77
|
| Rate for Payer: Zelis Auto |
$435.60
|
| Rate for Payer: Zelis Worker's Compensation |
$297.30
|
|
|
INSERT SPINE FIXATION DEVICE
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 22843
|
| Hospital Charge Code |
6122843
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$476.38 |
| Max. Negotiated Rate |
$1,657.75 |
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$1,483.25
|
| Rate for Payer: First Health Commercial |
$1,570.50
|
| Rate for Payer: First Health Workers Compensation |
$673.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,570.50
|
| Rate for Payer: GEHA Commercial |
$1,221.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,570.50
|
| Rate for Payer: Multiplan All |
$1,587.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,221.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,570.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,657.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,308.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,622.85
|
| Rate for Payer: Zelis Auto |
$698.00
|
| Rate for Payer: Zelis Worker's Compensation |
$476.38
|
|
|
INSERT SPINE FIXATION DEVICE
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 22843
|
| Hospital Charge Code |
6122843
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$436.25 |
| Max. Negotiated Rate |
$1,657.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,047.00
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$1,483.25
|
| Rate for Payer: First Health Commercial |
$1,570.50
|
| Rate for Payer: First Health Workers Compensation |
$673.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,570.50
|
| Rate for Payer: GEHA Commercial |
$1,396.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,570.50
|
| Rate for Payer: Humana ChoiceCare |
$453.70
|
| Rate for Payer: Multiplan All |
$1,587.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,047.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,221.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,570.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,657.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,308.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,535.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$436.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,622.85
|
| Rate for Payer: Zelis Auto |
$698.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$872.50
|
| Rate for Payer: Zelis Worker's Compensation |
$476.38
|
|
|
INSERT SPINE INFUSION DEVICE
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 62360
|
| Hospital Charge Code |
6162360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$33,564.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,148.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,148.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,286.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16,782.28
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$646.40
|
| Rate for Payer: GEHA Medicare |
$16,782.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Humana ChoiceCare |
$18,460.51
|
| Rate for Payer: Humana Medicare Advantage |
$16,782.28
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,194.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,353.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16,782.28
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,529.88
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,871.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,353.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16,782.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33,564.56
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,446.63
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,353.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,782.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16,782.28
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Medicare |
$14,264.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,138.74
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
INSERT SPINE INFUSION DEVICE
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 62360
|
| Hospital Charge Code |
6162360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
IP
|
$14,790.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
4210022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,037.67 |
| Max. Negotiated Rate |
$14,050.50 |
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cigna Commercial |
$12,571.50
|
| Rate for Payer: First Health Commercial |
$13,311.00
|
| Rate for Payer: First Health Workers Compensation |
$5,710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,311.00
|
| Rate for Payer: GEHA Commercial |
$10,353.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,311.00
|
| Rate for Payer: Multiplan All |
$13,458.90
|
| Rate for Payer: OMNI Networks Commercial |
$10,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,311.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,050.50
|
| Rate for Payer: Three Rivers Provider Network All |
$11,092.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,754.70
|
| Rate for Payer: Zelis Auto |
$5,916.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4,037.67
|
|
