|
INS MARK THOR FOR RT PERQ
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
6132553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$515.10
|
| Rate for Payer: First Health Commercial |
$545.40
|
| Rate for Payer: First Health Workers Compensation |
$233.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$545.40
|
| Rate for Payer: GEHA Commercial |
$424.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$545.40
|
| Rate for Payer: Multiplan All |
$551.46
|
| Rate for Payer: OMNI Networks Commercial |
$424.20
|
| Rate for Payer: One Health Plan PPO/POS |
$545.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$575.70
|
| Rate for Payer: Three Rivers Provider Network All |
$454.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$563.58
|
| Rate for Payer: Zelis Auto |
$242.40
|
| Rate for Payer: Zelis Worker's Compensation |
$165.44
|
|
|
INS MARK THOR FOR RT PERQ
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
6132553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.44 |
| 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 |
$363.60
|
| 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 |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$515.10
|
| Rate for Payer: First Health Commercial |
$545.40
|
| Rate for Payer: First Health Workers Compensation |
$233.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$545.40
|
| Rate for Payer: GEHA Commercial |
$484.80
|
| Rate for Payer: GEHA Medicare |
$1,299.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$545.40
|
| 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 |
$551.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,208.67
|
| Rate for Payer: OMNI Networks Commercial |
$424.20
|
| Rate for Payer: One Health Plan PPO/POS |
$545.40
|
| 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 |
$575.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,598.44
|
| Rate for Payer: Three Rivers Provider Network All |
$454.50
|
| 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 |
$563.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,299.22
|
| Rate for Payer: Zelis Auto |
$242.40
|
| 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 |
$165.44
|
|
|
INSOLES
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
8230076
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$67.73
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: First Health Commercial |
$86.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$86.40
|
| Rate for Payer: GEHA Commercial |
$76.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$86.40
|
| Rate for Payer: Humana ChoiceCare |
$24.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$69.11
|
| Rate for Payer: Multiplan All |
$87.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$57.60
|
| Rate for Payer: OMNI Networks Commercial |
$67.20
|
| Rate for Payer: One Health Plan PPO/POS |
$86.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$79.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$69.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$91.20
|
| Rate for Payer: Three Rivers Provider Network All |
$72.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$84.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$89.28
|
| Rate for Payer: Zelis Auto |
$38.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$48.00
|
|
|
INSOLES
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
8800018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$67.73
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: First Health Commercial |
$86.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$86.40
|
| Rate for Payer: GEHA Commercial |
$76.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$86.40
|
| Rate for Payer: Humana ChoiceCare |
$24.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$69.11
|
| Rate for Payer: Multiplan All |
$87.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$57.60
|
| Rate for Payer: OMNI Networks Commercial |
$67.20
|
| Rate for Payer: One Health Plan PPO/POS |
$86.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$79.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$69.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$91.20
|
| Rate for Payer: Three Rivers Provider Network All |
$72.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$84.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$89.28
|
| Rate for Payer: Zelis Auto |
$38.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$48.00
|
|
|
INSOLES
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
8230076
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: First Health Commercial |
$86.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$86.40
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$86.40
|
| Rate for Payer: Multiplan All |
$87.36
|
| Rate for Payer: OMNI Networks Commercial |
$67.20
|
| Rate for Payer: One Health Plan PPO/POS |
$86.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$91.20
|
| Rate for Payer: Three Rivers Provider Network All |
$72.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$89.28
|
| Rate for Payer: Zelis Auto |
$38.40
|
|
|
INSOLES
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
8800018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: First Health Commercial |
$86.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$86.40
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$86.40
|
| Rate for Payer: Multiplan All |
$87.36
|
| Rate for Payer: OMNI Networks Commercial |
$67.20
|
| Rate for Payer: One Health Plan PPO/POS |
$86.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$91.20
|
| Rate for Payer: Three Rivers Provider Network All |
$72.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$89.28
|
| Rate for Payer: Zelis Auto |
$38.40
|
|
|
INS/RPLCMT MECH-ELEC NTRFCE
|
Facility
|
IP
|
$10,617.00
|
|
|
Service Code
|
CPT 0453T
|
| Hospital Charge Code |
6191044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,898.44 |
| Max. Negotiated Rate |
$10,086.15 |
| Rate for Payer: Cash Price |
$6,370.20
|
| Rate for Payer: Cigna Commercial |
$9,024.45
|
| Rate for Payer: First Health Commercial |
$9,555.30
|
| Rate for Payer: First Health Workers Compensation |
$4,099.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,555.30
|
| Rate for Payer: GEHA Commercial |
$7,431.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,555.30
|
| Rate for Payer: Multiplan All |
$9,661.47
|
| Rate for Payer: OMNI Networks Commercial |
$7,431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,086.15
|
| Rate for Payer: Three Rivers Provider Network All |
$7,962.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,873.81
|
| Rate for Payer: Zelis Auto |
$4,246.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,898.44
|
|
|
INS/RPLCMT MECH-ELEC NTRFCE
|
Facility
|
OP
|
$10,617.00
|
|
|
Service Code
|
CPT 0453T
|
| Hospital Charge Code |
6191044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,654.25 |
| Max. Negotiated Rate |
$10,086.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,370.20
|
| Rate for Payer: Cash Price |
$6,370.20
|
| Rate for Payer: Cigna Commercial |
$9,024.45
|
| Rate for Payer: First Health Commercial |
$9,555.30
|
| Rate for Payer: First Health Workers Compensation |
$4,099.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,555.30
|
| Rate for Payer: GEHA Commercial |
$8,493.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,555.30
|
| Rate for Payer: Humana ChoiceCare |
$2,760.42
|
| Rate for Payer: Multiplan All |
$9,661.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,370.20
|
| Rate for Payer: OMNI Networks Commercial |
$7,431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,086.15
|
| Rate for Payer: Three Rivers Provider Network All |
$7,962.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,342.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,654.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,873.81
|
| Rate for Payer: Zelis Auto |
$4,246.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,308.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,898.44
|
|
|
INS/RPLCMT SUBQ ELECTRODE
|
Facility
|
OP
|
$10,617.00
|
|
|
Service Code
|
CPT 0454T
|
| Hospital Charge Code |
6191045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,654.25 |
| Max. Negotiated Rate |
$10,086.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,370.20
|
| Rate for Payer: Cash Price |
$6,370.20
|
| Rate for Payer: Cigna Commercial |
$9,024.45
|
| Rate for Payer: First Health Commercial |
$9,555.30
|
| Rate for Payer: First Health Workers Compensation |
$4,099.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,555.30
|
| Rate for Payer: GEHA Commercial |
$8,493.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,555.30
|
| Rate for Payer: Humana ChoiceCare |
$2,760.42
|
| Rate for Payer: Multiplan All |
$9,661.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,370.20
|
| Rate for Payer: OMNI Networks Commercial |
$7,431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,086.15
|
| Rate for Payer: Three Rivers Provider Network All |
$7,962.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,342.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,654.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,873.81
|
| Rate for Payer: Zelis Auto |
$4,246.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,308.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,898.44
|
|
|
INS/RPLCMT SUBQ ELECTRODE
|
Facility
|
IP
|
$10,617.00
|
|
|
Service Code
|
CPT 0454T
|
| Hospital Charge Code |
6191045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,898.44 |
| Max. Negotiated Rate |
$10,086.15 |
| Rate for Payer: Cash Price |
$6,370.20
|
| Rate for Payer: Cigna Commercial |
$9,024.45
|
| Rate for Payer: First Health Commercial |
$9,555.30
|
| Rate for Payer: First Health Workers Compensation |
$4,099.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,555.30
|
| Rate for Payer: GEHA Commercial |
$7,431.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,555.30
|
| Rate for Payer: Multiplan All |
$9,661.47
|
| Rate for Payer: OMNI Networks Commercial |
$7,431.90
|
| Rate for Payer: One Health Plan PPO/POS |
$9,555.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,086.15
|
| Rate for Payer: Three Rivers Provider Network All |
$7,962.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,873.81
|
| Rate for Payer: Zelis Auto |
$4,246.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,898.44
|
|
|
INSRTION TRAY W/BAG 2-WAY LATEX
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT A4314
|
| Hospital Charge Code |
8504314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$232.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
INSRTION TRAY W/BAG 2-WAY LATEX
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT A4314
|
| Hospital Charge Code |
8504314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$39.04
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$298.80
|
| Rate for Payer: First Health Workers Compensation |
$128.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$298.80
|
| Rate for Payer: GEHA Commercial |
$265.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$298.80
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$39.83
|
| Rate for Payer: Multiplan All |
$302.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$199.20
|
| Rate for Payer: OMNI Networks Commercial |
$232.40
|
| Rate for Payer: One Health Plan PPO/POS |
$298.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$39.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$315.40
|
| Rate for Payer: Three Rivers Provider Network All |
$249.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$292.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$308.76
|
| Rate for Payer: Zelis Auto |
$132.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.64
|
|
|
INSRTION TRAY W/DRN BAG W/O CATH
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
8504354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.97
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.33
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INSRTION TRAY W/DRN BAG W/O CATH
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT A4354
|
| Hospital Charge Code |
8504354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INSRT NEEDLE BONE CAVITY (INTRAOSSEOUS)
|
Facility
|
IP
|
$462.00
|
|
| Hospital Charge Code |
8136680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$323.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| Rate for Payer: Multiplan All |
$420.42
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$438.90
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$429.66
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
INSRT NEEDLE BONE CAVITY (INTRAOSSEOUS)
|
Facility
|
OP
|
$462.00
|
|
| Hospital Charge Code |
8136680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| Rate for Payer: Humana ChoiceCare |
$120.12
|
| Rate for Payer: Multiplan All |
$420.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$277.20
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$438.90
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$406.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$429.66
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.00
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
INSRT PULSE GEN W/SINGL LEAD
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
6133240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.54 |
| Max. Negotiated Rate |
$941.45 |
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cigna Commercial |
$842.35
|
| Rate for Payer: First Health Commercial |
$891.90
|
| Rate for Payer: First Health Workers Compensation |
$382.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.90
|
| Rate for Payer: GEHA Commercial |
$693.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.90
|
| Rate for Payer: Multiplan All |
$901.81
|
| Rate for Payer: OMNI Networks Commercial |
$693.70
|
| Rate for Payer: One Health Plan PPO/POS |
$891.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$941.45
|
| Rate for Payer: Three Rivers Provider Network All |
$743.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$921.63
|
| Rate for Payer: Zelis Auto |
$396.40
|
| Rate for Payer: Zelis Worker's Compensation |
$270.54
|
|
|
INSRT PULSE GEN W/SINGL LEAD
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT 33240
|
| Hospital Charge Code |
6133240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.54 |
| Max. Negotiated Rate |
$42,627.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32,944.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$594.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32,944.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26,098.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21,313.56
|
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cigna Commercial |
$842.35
|
| Rate for Payer: First Health Commercial |
$891.90
|
| Rate for Payer: First Health Workers Compensation |
$382.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.90
|
| Rate for Payer: GEHA Commercial |
$792.80
|
| Rate for Payer: GEHA Medicare |
$21,313.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.90
|
| Rate for Payer: Humana ChoiceCare |
$23,444.92
|
| Rate for Payer: Humana Medicare Advantage |
$21,313.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35,806.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26,629.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21,313.56
|
| Rate for Payer: Multiplan All |
$901.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36,233.05
|
| Rate for Payer: OMNI Networks Commercial |
$693.70
|
| Rate for Payer: One Health Plan PPO/POS |
$891.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30,747.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26,629.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21,313.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$941.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$42,627.12
|
| Rate for Payer: Three Rivers Provider Network All |
$743.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20,887.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26,629.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,313.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$921.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21,313.56
|
| Rate for Payer: Zelis Auto |
$396.40
|
| Rate for Payer: Zelis Medicare |
$18,116.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25,576.27
|
| Rate for Payer: Zelis Worker's Compensation |
$270.54
|
|
|
INSRT/REDO NEUROSTIM 1 ARRAY
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 61885
|
| Hospital Charge Code |
6161885
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$295.39 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: First Health Workers Compensation |
$417.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$757.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: Zelis Auto |
$432.80
|
| Rate for Payer: Zelis Worker's Compensation |
$295.39
|
|
|
INSRT/REDO NEUROSTIM 1 ARRAY
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT 61885
|
| Hospital Charge Code |
6161885
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$295.39 |
| Max. Negotiated Rate |
$40,724.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$649.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16,508.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20,362.31
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$919.70
|
| Rate for Payer: First Health Commercial |
$973.80
|
| Rate for Payer: First Health Workers Compensation |
$417.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$973.80
|
| Rate for Payer: GEHA Commercial |
$865.60
|
| Rate for Payer: GEHA Medicare |
$20,362.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$973.80
|
| Rate for Payer: Humana ChoiceCare |
$22,398.54
|
| Rate for Payer: Humana Medicare Advantage |
$20,362.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34,208.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16,844.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20,362.31
|
| Rate for Payer: Multiplan All |
$984.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34,615.93
|
| Rate for Payer: OMNI Networks Commercial |
$757.40
|
| Rate for Payer: One Health Plan PPO/POS |
$973.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19,449.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,844.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20,362.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,027.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40,724.62
|
| Rate for Payer: Three Rivers Provider Network All |
$811.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,955.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,844.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,362.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,006.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20,362.31
|
| Rate for Payer: Zelis Auto |
$432.80
|
| Rate for Payer: Zelis Medicare |
$17,307.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24,434.77
|
| Rate for Payer: Zelis Worker's Compensation |
$295.39
|
|
|
INSRT/REDO PN/GASTR STIMUL
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
6164590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$40,724.62 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16,508.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20,362.31
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$393.60
|
| Rate for Payer: GEHA Medicare |
$20,362.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Humana ChoiceCare |
$22,398.54
|
| Rate for Payer: Humana Medicare Advantage |
$20,362.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34,208.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16,844.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20,362.31
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34,615.93
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19,449.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,844.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20,362.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40,724.62
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19,955.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,844.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,362.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20,362.31
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Medicare |
$17,307.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24,434.77
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
INSRT/REDO PN/GASTR STIMUL
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
6164590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
INSRT/REDO SPINE N GENERATOR
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
6163685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.91 |
| Max. Negotiated Rate |
$57,871.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,002.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16,508.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28,935.89
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cigna Commercial |
$1,419.50
|
| Rate for Payer: First Health Commercial |
$1,503.00
|
| Rate for Payer: First Health Workers Compensation |
$644.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.00
|
| Rate for Payer: GEHA Commercial |
$1,336.00
|
| Rate for Payer: GEHA Medicare |
$28,935.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.00
|
| Rate for Payer: Humana ChoiceCare |
$31,829.48
|
| Rate for Payer: Humana Medicare Advantage |
$28,935.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$48,612.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16,844.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28,935.89
|
| Rate for Payer: Multiplan All |
$1,519.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49,191.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19,449.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,844.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28,935.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,586.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$57,871.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,252.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28,357.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,844.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,935.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,553.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28,935.89
|
| Rate for Payer: Zelis Auto |
$668.00
|
| Rate for Payer: Zelis Medicare |
$24,595.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34,723.07
|
| Rate for Payer: Zelis Worker's Compensation |
$455.91
|
|
|
INSRT/REDO SPINE N GENERATOR
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
6163685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.91 |
| Max. Negotiated Rate |
$1,586.50 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cigna Commercial |
$1,419.50
|
| Rate for Payer: First Health Commercial |
$1,503.00
|
| Rate for Payer: First Health Workers Compensation |
$644.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.00
|
| Rate for Payer: GEHA Commercial |
$1,169.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.00
|
| Rate for Payer: Multiplan All |
$1,519.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,586.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,252.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,553.10
|
| Rate for Payer: Zelis Auto |
$668.00
|
| Rate for Payer: Zelis Worker's Compensation |
$455.91
|
|
|
INS STABL DEV WO DCMPRN
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 22870
|
| Hospital Charge Code |
6191087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
