|
INSJ MESH/PROSTH PELVC FLR DEFECT EA SIT
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 57267
|
| Hospital Charge Code |
23500064
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$3,565.77 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cigna Commercial |
$559.30
|
| Rate for Payer: First Health Commercial |
$592.20
|
| Rate for Payer: First Health Workers Compensation |
$254.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$592.20
|
| Rate for Payer: GEHA Commercial |
$526.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$592.20
|
| Rate for Payer: Humana ChoiceCare |
$171.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Multiplan All |
$598.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$394.80
|
| Rate for Payer: OMNI Networks Commercial |
$460.60
|
| Rate for Payer: One Health Plan PPO/POS |
$592.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$625.10
|
| Rate for Payer: Three Rivers Provider Network All |
$493.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$579.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.94
|
| Rate for Payer: Zelis Auto |
$263.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$329.00
|
| Rate for Payer: Zelis Worker's Compensation |
$179.63
|
|
|
INSJ MESH/PROSTH PELVC FLR DEFECT EA SIT
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 57267
|
| Hospital Charge Code |
23500064
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$179.63 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cigna Commercial |
$559.30
|
| Rate for Payer: First Health Commercial |
$592.20
|
| Rate for Payer: First Health Workers Compensation |
$254.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$592.20
|
| Rate for Payer: GEHA Commercial |
$460.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$592.20
|
| Rate for Payer: Multiplan All |
$598.78
|
| Rate for Payer: OMNI Networks Commercial |
$460.60
|
| Rate for Payer: One Health Plan PPO/POS |
$592.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$625.10
|
| Rate for Payer: Three Rivers Provider Network All |
$493.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.94
|
| Rate for Payer: Zelis Auto |
$263.20
|
| Rate for Payer: Zelis Worker's Compensation |
$179.63
|
|
|
INSJ NON-BIODEGRADABLE DRUG DELIVERY IMP
|
Facility
|
OP
|
$282.54
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
6111981
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
INSJ NON-BIODEGRADABLE DRUG DELIVERY IMP
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
23500070
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
INSJ NON-BIODEGRADABLE DRUG DELIVERY IMP
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
23500070
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$409.45 |
| 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 |
$258.60
|
| 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 |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| 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 |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| 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 |
$409.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| 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 |
$400.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
INSJ NON-BIODEGRADABLE DRUG DELIVERY IMP
|
Facility
|
IP
|
$282.54
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
6111981
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
23500015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
IP
|
$364.00
|
|
| Hospital Charge Code |
8151701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$140.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$254.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Worker's Compensation |
$99.37
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
6151701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
21600116
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
10051701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
21600116
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
OP
|
$364.00
|
|
| Hospital Charge Code |
8151701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$140.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Humana ChoiceCare |
$94.64
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$320.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$99.37
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
23500015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
INSJ NON-NDWELLG BLADDER CATHETER
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
6151701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
INSJ NON-TUNN CENTRAL VENOUS CATH 5 YR/>
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
8150093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.29 |
| Max. Negotiated Rate |
$2,913.65 |
| Rate for Payer: Cash Price |
$1,840.20
|
| Rate for Payer: Cigna Commercial |
$2,606.95
|
| Rate for Payer: First Health Commercial |
$2,760.30
|
| Rate for Payer: First Health Workers Compensation |
$1,184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,760.30
|
| Rate for Payer: GEHA Commercial |
$2,146.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,760.30
|
| Rate for Payer: Multiplan All |
$2,790.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,146.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,760.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,913.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,300.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,852.31
|
| Rate for Payer: Zelis Auto |
$1,226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$837.29
|
|
|
INSJ NON-TUNN CENTRAL VENOUS CATH 5 YR/>
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
6136556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.71 |
| 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 |
$162.00
|
| 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 |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$216.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| 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 |
$245.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| 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 |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| 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 |
$251.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$108.00
|
| 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 |
$73.71
|
|
|
INSJ NON-TUNN CENTRAL VENOUS CATH 5 YR/>
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
8150093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$766.75 |
| Max. Negotiated Rate |
$2,913.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,840.20
|
| Rate for Payer: Cash Price |
$1,840.20
|
| Rate for Payer: Cigna Commercial |
$2,606.95
|
| Rate for Payer: First Health Commercial |
$2,760.30
|
| Rate for Payer: First Health Workers Compensation |
$1,184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,760.30
|
| Rate for Payer: GEHA Commercial |
$2,453.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,760.30
|
| Rate for Payer: Humana ChoiceCare |
$797.42
|
| Rate for Payer: Multiplan All |
$2,790.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,840.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,146.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,760.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,913.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,300.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,698.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$766.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,852.31
|
| Rate for Payer: Zelis Auto |
$1,226.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,533.50
|
| Rate for Payer: Zelis Worker's Compensation |
$837.29
|
|
|
INSJ NON-TUNN CENTRAL VENOUS CATH 5 YR/>
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
6136556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$189.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Worker's Compensation |
$73.71
|
|
|
INSJ NON-TUNN CENTRAL VENOUS CATH 5 YR/>
|
Facility
|
IP
|
$3,067.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
10036556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.29 |
| Max. Negotiated Rate |
$2,913.65 |
| Rate for Payer: Cash Price |
$1,840.20
|
| Rate for Payer: Cigna Commercial |
$2,606.95
|
| Rate for Payer: First Health Commercial |
$2,760.30
|
| Rate for Payer: First Health Workers Compensation |
$1,184.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,760.30
|
| Rate for Payer: GEHA Commercial |
$2,146.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,760.30
|
| Rate for Payer: Multiplan All |
$2,790.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,146.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,760.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,913.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,300.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,852.31
|
| Rate for Payer: Zelis Auto |
$1,226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$837.29
|
|
|
INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
6136571
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$939.55 |
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cigna Commercial |
$840.65
|
| Rate for Payer: First Health Commercial |
$890.10
|
| Rate for Payer: First Health Workers Compensation |
$381.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$890.10
|
| Rate for Payer: GEHA Commercial |
$692.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$890.10
|
| Rate for Payer: Multiplan All |
$899.99
|
| Rate for Payer: OMNI Networks Commercial |
$692.30
|
| Rate for Payer: One Health Plan PPO/POS |
$890.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$939.55
|
| Rate for Payer: Three Rivers Provider Network All |
$741.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$919.77
|
| Rate for Payer: Zelis Auto |
$395.60
|
| Rate for Payer: Zelis Worker's Compensation |
$270.00
|
|
|
INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
6136571
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.00 |
| 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 |
$593.40
|
| 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 |
$593.40
|
| Rate for Payer: Cash Price |
$593.40
|
| Rate for Payer: Cigna Commercial |
$840.65
|
| Rate for Payer: First Health Commercial |
$890.10
|
| Rate for Payer: First Health Workers Compensation |
$381.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$890.10
|
| Rate for Payer: GEHA Commercial |
$791.20
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$890.10
|
| 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 |
$899.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$692.30
|
| Rate for Payer: One Health Plan PPO/POS |
$890.10
|
| 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 |
$939.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$741.75
|
| 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 |
$919.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$395.60
|
| 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 |
$270.00
|
|
|
INSJ/RPLCMT PERQ ELTRD RA PN INT NSTIM E
|
Facility
|
OP
|
$584.16
|
|
|
Service Code
|
CPT 64597
|
| Hospital Charge Code |
6164597
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.04 |
| Max. Negotiated Rate |
$554.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.50
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$496.54
|
| Rate for Payer: First Health Commercial |
$525.74
|
| Rate for Payer: First Health Workers Compensation |
$225.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.74
|
| Rate for Payer: GEHA Commercial |
$467.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.74
|
| Rate for Payer: Humana ChoiceCare |
$151.88
|
| Rate for Payer: Multiplan All |
$531.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.50
|
| Rate for Payer: OMNI Networks Commercial |
$408.91
|
| Rate for Payer: One Health Plan PPO/POS |
$525.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.95
|
| Rate for Payer: Three Rivers Provider Network All |
$438.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$514.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$146.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.27
|
| Rate for Payer: Zelis Auto |
$233.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$292.08
|
| Rate for Payer: Zelis Worker's Compensation |
$159.48
|
|
|
INSJ/RPLCMT PERQ ELTRD RA PN INT NSTIM E
|
Facility
|
IP
|
$584.16
|
|
|
Service Code
|
CPT 64597
|
| Hospital Charge Code |
6164597
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.48 |
| Max. Negotiated Rate |
$554.95 |
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$496.54
|
| Rate for Payer: First Health Commercial |
$525.74
|
| Rate for Payer: First Health Workers Compensation |
$225.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.74
|
| Rate for Payer: GEHA Commercial |
$408.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.74
|
| Rate for Payer: Multiplan All |
$531.59
|
| Rate for Payer: OMNI Networks Commercial |
$408.91
|
| Rate for Payer: One Health Plan PPO/POS |
$525.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.95
|
| Rate for Payer: Three Rivers Provider Network All |
$438.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.27
|
| Rate for Payer: Zelis Auto |
$233.66
|
| Rate for Payer: Zelis Worker's Compensation |
$159.48
|
|
|
INSJ/RPLCMT PERQ ELTRD RA PN W/INT NSTIM
|
Facility
|
IP
|
$1,947.25
|
|
|
Service Code
|
CPT 64596
|
| Hospital Charge Code |
6164596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$531.60 |
| Max. Negotiated Rate |
$1,849.89 |
| Rate for Payer: Cash Price |
$1,168.35
|
| Rate for Payer: Cigna Commercial |
$1,655.16
|
| Rate for Payer: First Health Commercial |
$1,752.53
|
| Rate for Payer: First Health Workers Compensation |
$751.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,752.53
|
| Rate for Payer: GEHA Commercial |
$1,363.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,752.53
|
| Rate for Payer: Multiplan All |
$1,772.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,363.08
|
| Rate for Payer: One Health Plan PPO/POS |
$1,752.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,849.89
|
| Rate for Payer: Three Rivers Provider Network All |
$1,460.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,810.94
|
| Rate for Payer: Zelis Auto |
$778.90
|
| Rate for Payer: Zelis Worker's Compensation |
$531.60
|
|
