|
INTMD RPR N-HF/GENIT20.1-30
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
6112046
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$308.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| Rate for Payer: Multiplan All |
$728.00
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$760.00
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$744.00
|
| Rate for Payer: Zelis Auto |
$320.00
|
| Rate for Payer: Zelis Worker's Compensation |
$218.40
|
|
|
INTMD RPR N-HF/GENIT >30.0CM
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 12047
|
| Hospital Charge Code |
6112047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
INTMD RPR N-HF/GENIT >30.0CM
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 12047
|
| Hospital Charge Code |
6112047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
INTMD RPR S/A/T/EXT 12.6-20
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
6112035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$369.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$237.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$492.80
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$168.17
|
|
|
INTMD RPR S/A/T/EXT 12.6-20
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
6112035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$237.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$431.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Worker's Compensation |
$168.17
|
|
|
INTMD RPR S/A/T/EXT 20.1-30
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
6112036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$612.00
|
| Rate for Payer: First Health Commercial |
$648.00
|
| Rate for Payer: First Health Workers Compensation |
$277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.00
|
| Rate for Payer: GEHA Commercial |
$504.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.00
|
| Rate for Payer: Multiplan All |
$655.20
|
| Rate for Payer: OMNI Networks Commercial |
$504.00
|
| Rate for Payer: One Health Plan PPO/POS |
$648.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.00
|
| Rate for Payer: Three Rivers Provider Network All |
$540.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$669.60
|
| Rate for Payer: Zelis Auto |
$288.00
|
| Rate for Payer: Zelis Worker's Compensation |
$196.56
|
|
|
INTMD RPR S/A/T/EXT 20.1-30
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
6112036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$612.00
|
| Rate for Payer: First Health Commercial |
$648.00
|
| Rate for Payer: First Health Workers Compensation |
$277.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.00
|
| Rate for Payer: GEHA Commercial |
$576.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.00
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$655.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$504.00
|
| Rate for Payer: One Health Plan PPO/POS |
$648.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$540.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$669.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$288.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$196.56
|
|
|
INTMD RPR S/TR/EXT >30.0 CM
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
6112037
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Worker's Compensation |
$229.87
|
|
|
INTMD RPR S/TR/EXT >30.0 CM
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
6112037
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$229.87
|
|
|
INTRACRANIAL VESSEL SURGERY
|
Facility
|
OP
|
$4,820.00
|
|
|
Service Code
|
CPT 61680
|
| Hospital Charge Code |
6161680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$4,579.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,892.00
|
| Rate for Payer: Cash Price |
$2,892.00
|
| Rate for Payer: Cigna Commercial |
$4,097.00
|
| Rate for Payer: First Health Commercial |
$4,338.00
|
| Rate for Payer: First Health Workers Compensation |
$1,861.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,338.00
|
| Rate for Payer: GEHA Commercial |
$3,856.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,338.00
|
| Rate for Payer: Humana ChoiceCare |
$1,253.20
|
| Rate for Payer: Multiplan All |
$4,386.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,892.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,374.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,338.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,579.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,615.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,241.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,205.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,482.60
|
| Rate for Payer: Zelis Auto |
$1,928.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,410.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,315.86
|
|
|
INTRACRANIAL VESSEL SURGERY
|
Facility
|
IP
|
$4,820.00
|
|
|
Service Code
|
CPT 61680
|
| Hospital Charge Code |
6161680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,315.86 |
| Max. Negotiated Rate |
$4,579.00 |
| Rate for Payer: Cash Price |
$2,892.00
|
| Rate for Payer: Cigna Commercial |
$4,097.00
|
| Rate for Payer: First Health Commercial |
$4,338.00
|
| Rate for Payer: First Health Workers Compensation |
$1,861.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,338.00
|
| Rate for Payer: GEHA Commercial |
$3,374.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,338.00
|
| Rate for Payer: Multiplan All |
$4,386.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,374.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,338.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,579.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,615.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,482.60
|
| Rate for Payer: Zelis Auto |
$1,928.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,315.86
|
|
|
INTRANASAL BIOPSY
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
6130100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$81.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$57.33
|
|
|
INTRANASAL BIOPSY
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
6130100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.33 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$81.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$147.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Worker's Compensation |
$57.33
|
|
|
INTRAOP COLON LAVAGE ADD-ON
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 44701
|
| Hospital Charge Code |
6144701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$322.20
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$429.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Humana ChoiceCare |
$139.62
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$322.20
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$472.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$134.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$268.50
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
|
INTRAOP COLON LAVAGE ADD-ON
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 44701
|
| Hospital Charge Code |
6144701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$375.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
|
INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPA
|
Facility
|
IP
|
$6,017.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
8141008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,642.64 |
| Max. Negotiated Rate |
$5,716.15 |
| Rate for Payer: Cash Price |
$3,610.20
|
| Rate for Payer: Cigna Commercial |
$5,114.45
|
| Rate for Payer: First Health Commercial |
$5,415.30
|
| Rate for Payer: First Health Workers Compensation |
$2,323.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,415.30
|
| Rate for Payer: GEHA Commercial |
$4,211.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,415.30
|
| Rate for Payer: Multiplan All |
$5,475.47
|
| Rate for Payer: OMNI Networks Commercial |
$4,211.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,415.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,716.15
|
| Rate for Payer: Three Rivers Provider Network All |
$4,512.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,595.81
|
| Rate for Payer: Zelis Auto |
$2,406.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,642.64
|
|
|
INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPA
|
Facility
|
OP
|
$6,017.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
8141008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,376.73 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,610.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$3,610.20
|
| Rate for Payer: Cash Price |
$3,610.20
|
| Rate for Payer: Cigna Commercial |
$5,114.45
|
| Rate for Payer: First Health Commercial |
$5,415.30
|
| Rate for Payer: First Health Workers Compensation |
$2,323.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,415.30
|
| Rate for Payer: GEHA Commercial |
$4,813.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,415.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$5,475.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$4,211.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,415.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,716.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$4,512.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,595.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$2,406.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$1,642.64
|
|
|
INTRAVENOUS INFUSION, SOTROVIMAB, INCLUD
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
8150247
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$356.72 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$683.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$683.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$541.47
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$1,097.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Humana ChoiceCare |
$356.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$552.50
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$823.20
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$637.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$552.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,207.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$552.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$686.00
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
INTRAVENOUS INFUSION, SOTROVIMAB, INCLUD
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
8150247
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$960.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
intrinsic factor blocking abs REF010413
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
2299257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$30.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$15.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.08
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.64
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.16
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.08
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.10
|
| Rate for Payer: Zelis Worker's Compensation |
$21.51
|
|
|
intrinsic factor blocking abs REF010413
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
2299257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$30.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.51
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
6191065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$284.19 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,025.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$624.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,025.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$812.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: First Health Workers Compensation |
$401.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$832.80
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$829.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$957.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$829.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$829.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$284.19
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
6191065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$284.19 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: First Health Workers Compensation |
$401.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$728.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Worker's Compensation |
$284.19
|
|
|
INTRO CATH DIALYSIS CIRC W TRANSCATHETER
|
Facility
|
IP
|
$14,842.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
6191047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$4,051.87 |
| Max. Negotiated Rate |
$14,099.90 |
| Rate for Payer: Cash Price |
$8,905.20
|
| Rate for Payer: Cigna Commercial |
$12,615.70
|
| Rate for Payer: First Health Commercial |
$13,357.80
|
| Rate for Payer: First Health Workers Compensation |
$5,730.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,357.80
|
| Rate for Payer: GEHA Commercial |
$10,389.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,357.80
|
| Rate for Payer: Multiplan All |
$13,506.22
|
| Rate for Payer: OMNI Networks Commercial |
$10,389.40
|
| Rate for Payer: One Health Plan PPO/POS |
$13,357.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,099.90
|
| Rate for Payer: Three Rivers Provider Network All |
$11,131.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,803.06
|
| Rate for Payer: Zelis Auto |
$5,936.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4,051.87
|
|
|
INTRO CATH DIALYSIS CIRC W TRANSCATHETER
|
Facility
|
OP
|
$14,842.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
6191047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$4,051.87 |
| Max. Negotiated Rate |
$21,536.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14,622.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,905.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14,622.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11,583.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,768.32
|
| Rate for Payer: Cash Price |
$8,905.20
|
| Rate for Payer: Cash Price |
$8,905.20
|
| Rate for Payer: Cigna Commercial |
$12,615.70
|
| Rate for Payer: First Health Commercial |
$13,357.80
|
| Rate for Payer: First Health Workers Compensation |
$5,730.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,357.80
|
| Rate for Payer: GEHA Commercial |
$11,873.60
|
| Rate for Payer: GEHA Medicare |
$10,768.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,357.80
|
| Rate for Payer: Humana ChoiceCare |
$11,845.15
|
| Rate for Payer: Humana Medicare Advantage |
$10,768.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18,090.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11,819.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,768.32
|
| Rate for Payer: Multiplan All |
$13,506.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18,306.14
|
| Rate for Payer: OMNI Networks Commercial |
$10,389.40
|
| Rate for Payer: One Health Plan PPO/POS |
$13,357.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13,647.63
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11,819.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,768.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,099.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21,536.64
|
| Rate for Payer: Three Rivers Provider Network All |
$11,131.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,552.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11,819.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,768.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,803.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10,768.32
|
| Rate for Payer: Zelis Auto |
$5,936.80
|
| Rate for Payer: Zelis Medicare |
$9,153.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12,921.98
|
| Rate for Payer: Zelis Worker's Compensation |
$4,051.87
|
|
