|
INSJ/RPLCMT PERQ ELTRD RA PN W/INT NSTIM
|
Facility
|
OP
|
$1,947.25
|
|
|
Service Code
|
CPT 64596
|
| Hospital Charge Code |
6164596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$486.81 |
| Max. Negotiated Rate |
$23,682.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,168.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11,841.06
|
| Rate for Payer: Cash Price |
$1,168.35
|
| 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 |
$1,557.80
|
| Rate for Payer: GEHA Medicare |
$11,841.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,752.53
|
| Rate for Payer: Humana ChoiceCare |
$13,025.17
|
| Rate for Payer: Humana Medicare Advantage |
$11,841.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19,892.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11,841.06
|
| Rate for Payer: Multiplan All |
$1,772.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,129.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,363.08
|
| Rate for Payer: One Health Plan PPO/POS |
$1,752.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11,841.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,849.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23,682.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,460.44
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,604.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$486.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,841.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,810.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11,841.06
|
| Rate for Payer: Zelis Auto |
$778.90
|
| Rate for Payer: Zelis Medicare |
$10,064.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,209.27
|
| Rate for Payer: Zelis Worker's Compensation |
$531.60
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER COMPL
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
10051703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER COMPL
|
Facility
|
OP
|
$648.00
|
|
| Hospital Charge Code |
8151703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$583.20
|
| Rate for Payer: First Health Workers Compensation |
$250.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$583.20
|
| Rate for Payer: GEHA Commercial |
$518.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$583.20
|
| Rate for Payer: Humana ChoiceCare |
$168.48
|
| Rate for Payer: Multiplan All |
$589.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$388.80
|
| Rate for Payer: OMNI Networks Commercial |
$453.60
|
| Rate for Payer: One Health Plan PPO/POS |
$583.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$615.60
|
| Rate for Payer: Three Rivers Provider Network All |
$486.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$570.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$162.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$602.64
|
| Rate for Payer: Zelis Auto |
$259.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$324.00
|
| Rate for Payer: Zelis Worker's Compensation |
$176.90
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER COMPL
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
6151703
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER COMPL
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
6151703
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna Commercial |
$214.20
|
| Rate for Payer: First Health Commercial |
$226.80
|
| Rate for Payer: First Health Workers Compensation |
$97.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$226.80
|
| Rate for Payer: GEHA Commercial |
$176.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$226.80
|
| Rate for Payer: Multiplan All |
$229.32
|
| Rate for Payer: OMNI Networks Commercial |
$176.40
|
| Rate for Payer: One Health Plan PPO/POS |
$226.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$239.40
|
| Rate for Payer: Three Rivers Provider Network All |
$189.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$234.36
|
| Rate for Payer: Zelis Auto |
$100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$68.80
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER COMPL
|
Facility
|
IP
|
$648.00
|
|
| Hospital Charge Code |
8151703
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.90 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$583.20
|
| Rate for Payer: First Health Workers Compensation |
$250.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$583.20
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$583.20
|
| Rate for Payer: Multiplan All |
$589.68
|
| Rate for Payer: OMNI Networks Commercial |
$453.60
|
| Rate for Payer: One Health Plan PPO/POS |
$583.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$615.60
|
| Rate for Payer: Three Rivers Provider Network All |
$486.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$602.64
|
| Rate for Payer: Zelis Auto |
$259.20
|
| Rate for Payer: Zelis Worker's Compensation |
$176.90
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
23500045
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
1000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$395.25
|
| Rate for Payer: First Health Commercial |
$418.50
|
| Rate for Payer: First Health Workers Compensation |
$179.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$418.50
|
| Rate for Payer: GEHA Commercial |
$325.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$418.50
|
| Rate for Payer: Multiplan All |
$423.15
|
| Rate for Payer: OMNI Networks Commercial |
$325.50
|
| Rate for Payer: One Health Plan PPO/POS |
$418.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$441.75
|
| Rate for Payer: Three Rivers Provider Network All |
$348.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$432.45
|
| Rate for Payer: Zelis Auto |
$186.00
|
| Rate for Payer: Zelis Worker's Compensation |
$126.94
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6151702
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| 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 |
$172.20
|
| 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 |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| 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 |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| 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 |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| 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 |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
21600117
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| 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 |
$172.20
|
| 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 |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| 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 |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| 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 |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| 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 |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
23500045
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| 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 |
$172.20
|
| 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 |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| 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 |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| 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 |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| 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 |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8900013
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8150091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| 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 |
$172.20
|
| 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 |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| 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 |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| 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 |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| 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 |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8900013
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| 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 |
$172.20
|
| 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 |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| 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 |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| 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 |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| 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 |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
21600117
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6151702
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TEMP NDWELLG BLADDER CATHETER SIMPL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8150091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
INSJ TUNNEL CVC W/O SUBQ PORT/PMP 5 YR/>
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
6136558
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| 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 |
$493.80
|
| 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 |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| 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 |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| 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 |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| 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 |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$329.20
|
| 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 |
$224.68
|
|
|
INSJ TUNNEL CVC W/O SUBQ PORT/PMP 5 YR/>
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
6136558
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
INSJ TUNNELED CTR VAD W/SUBQ PORT 5 YR/>
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
6136561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$1,014.60 |
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$907.80
|
| Rate for Payer: First Health Commercial |
$961.20
|
| Rate for Payer: First Health Workers Compensation |
$412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$961.20
|
| Rate for Payer: GEHA Commercial |
$747.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$961.20
|
| Rate for Payer: Multiplan All |
$971.88
|
| Rate for Payer: OMNI Networks Commercial |
$747.60
|
| Rate for Payer: One Health Plan PPO/POS |
$961.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,014.60
|
| Rate for Payer: Three Rivers Provider Network All |
$801.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$993.24
|
| Rate for Payer: Zelis Auto |
$427.20
|
| Rate for Payer: Zelis Worker's Compensation |
$291.56
|
|
|
INSJ TUNNELED CTR VAD W/SUBQ PORT 5 YR/>
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
6136561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$640.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$907.80
|
| Rate for Payer: First Health Commercial |
$961.20
|
| Rate for Payer: First Health Workers Compensation |
$412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$961.20
|
| Rate for Payer: GEHA Commercial |
$854.40
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$961.20
|
| 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 |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$971.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$747.60
|
| Rate for Payer: One Health Plan PPO/POS |
$961.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,014.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$801.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$993.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$427.20
|
| 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 |
$291.56
|
|
|
INSJ TUNNELED CTR VAD W/SUBQ PUMP
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
CPT 36563
|
| Hospital Charge Code |
6136563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$1,112.45 |
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$819.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
INSJ TUNNELED CTR VAD W/SUBQ PUMP
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
CPT 36563
|
| Hospital Charge Code |
6136563
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$936.80
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
INS MARK ABD/PEL FOR RT PERQ
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 49411
|
| Hospital Charge Code |
6149411
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
INS MARK ABD/PEL FOR RT PERQ
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 49411
|
| Hospital Charge Code |
6149411
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$2,598.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,557.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,557.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,233.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,299.22
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: GEHA Medicare |
$1,299.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$1,429.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,299.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,182.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,258.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,299.22
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,208.67
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,453.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,258.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,299.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,598.44
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,273.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,258.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,299.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,299.22
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Medicare |
$1,104.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,559.06
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
