|
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 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 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 |
$39,008.34 |
| 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 |
$19,504.17
|
| 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 |
$19,504.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,499.40
|
| Rate for Payer: Humana ChoiceCare |
$21,454.59
|
| Rate for Payer: Humana Medicare Advantage |
$19,504.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,767.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,504.17
|
| Rate for Payer: Multiplan All |
$1,516.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33,157.09
|
| 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 |
$19,504.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,582.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39,008.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,249.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,114.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$416.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,504.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,549.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,504.17
|
| Rate for Payer: Zelis Auto |
$666.40
|
| Rate for Payer: Zelis Medicare |
$16,578.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23,405.00
|
| Rate for Payer: Zelis Worker's Compensation |
$454.82
|
|
|
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 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 |
$2,870.66 |
| 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 |
$1,435.33
|
| 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 |
$1,435.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$1,578.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,411.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,435.33
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.06
|
| 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 |
$1,435.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,870.66
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,406.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,435.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Medicare |
$1,220.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
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 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 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 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 |
$6,099.72 |
| 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 |
$3,049.86
|
| 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 |
$3,049.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.90
|
| Rate for Payer: Humana ChoiceCare |
$3,354.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,049.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,123.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,049.86
|
| Rate for Payer: Multiplan All |
$337.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,184.76
|
| 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 |
$3,049.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$352.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,099.72
|
| Rate for Payer: Three Rivers Provider Network All |
$278.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,988.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,049.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$345.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,049.86
|
| Rate for Payer: Zelis Auto |
$148.40
|
| Rate for Payer: Zelis Medicare |
$2,592.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,659.83
|
| Rate for Payer: Zelis Worker's Compensation |
$101.28
|
|
|
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 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 |
$6,099.72 |
| 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 |
$3,049.86
|
| 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 |
$3,049.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$949.50
|
| Rate for Payer: Humana ChoiceCare |
$3,354.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,049.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,123.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,070.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,049.86
|
| Rate for Payer: Multiplan All |
$960.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,184.76
|
| 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 |
$3,049.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,002.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,099.72
|
| Rate for Payer: Three Rivers Provider Network All |
$791.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,988.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,049.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$981.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,049.86
|
| Rate for Payer: Zelis Auto |
$422.00
|
| Rate for Payer: Zelis Medicare |
$2,592.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,659.83
|
| Rate for Payer: Zelis Worker's Compensation |
$288.01
|
|
|
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 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 |
$3,969.94 |
| 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 |
$1,984.97
|
| 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 |
$1,984.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$235.80
|
| Rate for Payer: Humana ChoiceCare |
$2,183.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,984.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,334.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,984.97
|
| Rate for Payer: Multiplan All |
$238.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,374.45
|
| 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 |
$1,984.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$248.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,969.94
|
| Rate for Payer: Three Rivers Provider Network All |
$196.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,945.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,984.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$243.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,984.97
|
| Rate for Payer: Zelis Auto |
$104.80
|
| Rate for Payer: Zelis Medicare |
$1,687.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,381.96
|
| Rate for Payer: Zelis Worker's Compensation |
$71.53
|
|
|
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 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 |
$16,038.52 |
| 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 |
$8,019.26
|
| 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 |
$8,019.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Humana ChoiceCare |
$8,821.19
|
| Rate for Payer: Humana Medicare Advantage |
$8,019.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13,472.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,022.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,019.26
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,632.74
|
| 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 |
$8,019.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16,038.52
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,858.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,022.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,019.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,019.26
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Medicare |
$6,816.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,623.11
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
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 |
$39,008.34 |
| 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 |
$19,504.17
|
| 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 |
$19,504.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.80
|
| Rate for Payer: Humana ChoiceCare |
$21,454.59
|
| Rate for Payer: Humana Medicare Advantage |
$19,504.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,767.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,504.17
|
| Rate for Payer: Multiplan All |
$1,221.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$33,157.09
|
| 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 |
$19,504.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,274.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$39,008.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,114.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$335.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,504.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,504.17
|
| Rate for Payer: Zelis Auto |
$536.80
|
| Rate for Payer: Zelis Medicare |
$16,578.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23,405.00
|
| Rate for Payer: Zelis Worker's Compensation |
$366.37
|
|
|
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 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 |
$25,178.80 |
| 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 |
$12,589.40
|
| 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 |
$12,589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$980.10
|
| Rate for Payer: Humana ChoiceCare |
$13,848.34
|
| Rate for Payer: Humana Medicare Advantage |
$12,589.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21,150.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,589.40
|
| Rate for Payer: Multiplan All |
$990.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,401.98
|
| 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 |
$12,589.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,034.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25,178.80
|
| Rate for Payer: Three Rivers Provider Network All |
$816.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,337.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$272.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,589.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,012.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,589.40
|
| Rate for Payer: Zelis Auto |
$435.60
|
| Rate for Payer: Zelis Medicare |
$10,700.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15,107.28
|
| 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
|
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 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 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 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 |
$34,251.74 |
| 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 |
$17,125.87
|
| 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 |
$17,125.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Humana ChoiceCare |
$18,838.46
|
| Rate for Payer: Humana Medicare Advantage |
$17,125.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,771.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,353.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,125.87
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,113.98
|
| 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 |
$17,125.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,251.74
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,783.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,353.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,125.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,125.87
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Medicare |
$14,556.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,551.04
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
6133285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$16,038.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,019.26
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$230.40
|
| Rate for Payer: GEHA Medicare |
$8,019.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Humana ChoiceCare |
$8,821.19
|
| Rate for Payer: Humana Medicare Advantage |
$8,019.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13,472.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,977.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,019.26
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,632.74
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,365.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,977.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,019.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$16,038.52
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,858.87
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,977.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,019.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,019.26
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Medicare |
$6,816.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,623.11
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
