|
IR BX ABD/RETROPERITNL
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 49180
|
| Hospital Charge Code |
2467174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$562.40 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$977.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$843.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$977.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$774.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$1,195.10
|
| Rate for Payer: First Health Commercial |
$1,265.40
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,265.40
|
| Rate for Payer: GEHA Commercial |
$1,124.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,265.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$790.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$1,279.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$984.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,265.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$912.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$790.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,335.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,054.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$790.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,307.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$562.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BX BONE TROCAR/NEEDLE DEEP
|
Facility
|
IP
|
$4,077.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
7720225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.02 |
| Max. Negotiated Rate |
$3,873.15 |
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cigna Commercial |
$3,465.45
|
| Rate for Payer: First Health Commercial |
$3,669.30
|
| Rate for Payer: First Health Workers Compensation |
$1,574.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,669.30
|
| Rate for Payer: GEHA Commercial |
$2,853.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,669.30
|
| Rate for Payer: Multiplan All |
$3,710.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,853.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,669.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,873.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,057.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,791.61
|
| Rate for Payer: Zelis Auto |
$1,630.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,113.02
|
|
|
IR BX BONE TROCAR/NEEDLE DEEP
|
Facility
|
OP
|
$4,077.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
7720225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$3,873.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,446.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cigna Commercial |
$3,465.45
|
| Rate for Payer: First Health Commercial |
$3,669.30
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,669.30
|
| Rate for Payer: GEHA Commercial |
$3,261.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,669.30
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$3,710.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,853.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,669.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,873.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,057.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,791.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,630.80
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BX BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
IP
|
$4,077.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
2420220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.02 |
| Max. Negotiated Rate |
$3,873.15 |
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cigna Commercial |
$3,465.45
|
| Rate for Payer: First Health Commercial |
$3,669.30
|
| Rate for Payer: First Health Workers Compensation |
$1,574.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,669.30
|
| Rate for Payer: GEHA Commercial |
$2,853.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,669.30
|
| Rate for Payer: Multiplan All |
$3,710.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,853.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,669.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,873.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,057.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,791.61
|
| Rate for Payer: Zelis Auto |
$1,630.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,113.02
|
|
|
IR BX BONE TROCAR/NEEDLE SUPERFICIAL
|
Facility
|
OP
|
$4,077.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
2420220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.03 |
| Max. Negotiated Rate |
$3,873.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,446.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$829.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$657.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cigna Commercial |
$3,465.45
|
| Rate for Payer: First Health Commercial |
$3,669.30
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,669.30
|
| Rate for Payer: GEHA Commercial |
$3,261.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,669.30
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$670.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$3,710.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,853.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,669.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$774.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$670.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,873.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,057.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$670.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,791.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,630.80
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BX BREAST US GUIDE w/CLIP
|
Facility
|
IP
|
$4,491.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
7719100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,226.04 |
| Max. Negotiated Rate |
$4,266.45 |
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cigna Commercial |
$3,817.35
|
| Rate for Payer: First Health Commercial |
$4,041.90
|
| Rate for Payer: First Health Workers Compensation |
$1,733.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,041.90
|
| Rate for Payer: GEHA Commercial |
$3,143.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,041.90
|
| Rate for Payer: Multiplan All |
$4,086.81
|
| Rate for Payer: OMNI Networks Commercial |
$3,143.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,041.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,266.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,368.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,176.63
|
| Rate for Payer: Zelis Auto |
$1,796.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,226.04
|
|
|
IR BX BREAST US GUIDE w/CLIP
|
Facility
|
OP
|
$4,491.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
7719100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.82 |
| Max. Negotiated Rate |
$4,266.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,694.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$976.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$773.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cigna Commercial |
$3,817.35
|
| Rate for Payer: First Health Commercial |
$4,041.90
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,041.90
|
| Rate for Payer: GEHA Commercial |
$3,592.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,041.90
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$789.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$4,086.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,143.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,041.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$911.68
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$789.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,266.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,368.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,176.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,796.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BX LIVER NEEDLE PERCUTANEOUS
|
Facility
|
IP
|
$3,459.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
7747000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$944.31 |
| Max. Negotiated Rate |
$3,286.05 |
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$2,940.15
|
| Rate for Payer: First Health Commercial |
$3,113.10
|
| Rate for Payer: First Health Workers Compensation |
$1,335.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,113.10
|
| Rate for Payer: GEHA Commercial |
$2,421.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,113.10
|
| Rate for Payer: Multiplan All |
$3,147.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,421.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,113.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,286.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,594.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,216.87
|
| Rate for Payer: Zelis Auto |
$1,383.60
|
| Rate for Payer: Zelis Worker's Compensation |
$944.31
|
|
|
IR BX LIVER NEEDLE PERCUTANEOUS
|
Facility
|
OP
|
$3,459.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
7747000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$774.28 |
| Max. Negotiated Rate |
$3,286.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$977.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,075.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$977.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$774.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$2,940.15
|
| Rate for Payer: First Health Commercial |
$3,113.10
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,113.10
|
| Rate for Payer: GEHA Commercial |
$2,767.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,113.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$790.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$3,147.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,421.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,113.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$912.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$790.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,286.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,594.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$790.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,216.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,383.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BX LUNG, PERC NDL
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
2407226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,225.22 |
| Max. Negotiated Rate |
$4,263.60 |
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cigna Commercial |
$3,814.80
|
| Rate for Payer: First Health Commercial |
$4,039.20
|
| Rate for Payer: First Health Workers Compensation |
$1,732.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,039.20
|
| Rate for Payer: GEHA Commercial |
$3,141.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,039.20
|
| Rate for Payer: Multiplan All |
$4,084.08
|
| Rate for Payer: OMNI Networks Commercial |
$3,141.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,039.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,263.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,366.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,173.84
|
| Rate for Payer: Zelis Auto |
$1,795.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,225.22
|
|
|
IR BX LUNG, PERC NDL
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
2407226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,307.71 |
| Max. Negotiated Rate |
$4,263.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,110.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,692.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,110.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,671.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cash Price |
$2,692.80
|
| Rate for Payer: Cigna Commercial |
$3,814.80
|
| Rate for Payer: First Health Commercial |
$4,039.20
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,039.20
|
| Rate for Payer: GEHA Commercial |
$3,590.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,039.20
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,705.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$4,084.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$3,141.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,039.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,969.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,705.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,263.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,366.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,705.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,173.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,795.20
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BX MUSCLE PERC NEEDL
|
Facility
|
IP
|
$1,181.00
|
|
| Hospital Charge Code |
2407244
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.41 |
| Max. Negotiated Rate |
$1,121.95 |
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$1,003.85
|
| Rate for Payer: First Health Commercial |
$1,062.90
|
| Rate for Payer: First Health Workers Compensation |
$455.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,062.90
|
| Rate for Payer: GEHA Commercial |
$826.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,062.90
|
| Rate for Payer: Multiplan All |
$1,074.71
|
| Rate for Payer: OMNI Networks Commercial |
$826.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,062.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,121.95
|
| Rate for Payer: Three Rivers Provider Network All |
$885.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,098.33
|
| Rate for Payer: Zelis Auto |
$472.40
|
| Rate for Payer: Zelis Worker's Compensation |
$322.41
|
|
|
IR BX MUSCLE PERC NEEDL
|
Facility
|
OP
|
$1,181.00
|
|
| Hospital Charge Code |
2407244
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.25 |
| Max. Negotiated Rate |
$1,121.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$1,003.85
|
| Rate for Payer: First Health Commercial |
$1,062.90
|
| Rate for Payer: First Health Workers Compensation |
$455.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,062.90
|
| Rate for Payer: GEHA Commercial |
$944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,062.90
|
| Rate for Payer: Humana ChoiceCare |
$307.06
|
| Rate for Payer: Multiplan All |
$1,074.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$708.60
|
| Rate for Payer: OMNI Networks Commercial |
$826.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,062.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,121.95
|
| Rate for Payer: Three Rivers Provider Network All |
$885.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,039.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$295.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,098.33
|
| Rate for Payer: Zelis Auto |
$472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$590.50
|
| Rate for Payer: Zelis Worker's Compensation |
$322.41
|
|
|
IR BX RENAL
|
Facility
|
OP
|
$3,766.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
7750200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$774.28 |
| Max. Negotiated Rate |
$3,577.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$977.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,259.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$977.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$774.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$2,259.60
|
| Rate for Payer: Cash Price |
$2,259.60
|
| Rate for Payer: Cigna Commercial |
$3,201.10
|
| Rate for Payer: First Health Commercial |
$3,389.40
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,389.40
|
| Rate for Payer: GEHA Commercial |
$3,012.80
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,389.40
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$790.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$3,427.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,636.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,389.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$912.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$790.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,577.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,824.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$790.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,502.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,506.40
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR BX RENAL
|
Facility
|
IP
|
$3,766.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
7750200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,028.12 |
| Max. Negotiated Rate |
$3,577.70 |
| Rate for Payer: Cash Price |
$2,259.60
|
| Rate for Payer: Cigna Commercial |
$3,201.10
|
| Rate for Payer: First Health Commercial |
$3,389.40
|
| Rate for Payer: First Health Workers Compensation |
$1,454.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,389.40
|
| Rate for Payer: GEHA Commercial |
$2,636.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,389.40
|
| Rate for Payer: Multiplan All |
$3,427.06
|
| Rate for Payer: OMNI Networks Commercial |
$2,636.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,389.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,577.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,824.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,502.38
|
| Rate for Payer: Zelis Auto |
$1,506.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,028.12
|
|
|
IR BX SOFT TISSUE NECK
|
Facility
|
OP
|
$3,370.00
|
|
| Hospital Charge Code |
2407241
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$842.50 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: First Health Workers Compensation |
$1,301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,696.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Humana ChoiceCare |
$876.20
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,022.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,965.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$842.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,685.00
|
| Rate for Payer: Zelis Worker's Compensation |
$920.01
|
|
|
IR BX SOFT TISSUE NECK
|
Facility
|
IP
|
$3,370.00
|
|
| Hospital Charge Code |
2407241
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$920.01 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: First Health Workers Compensation |
$1,301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,359.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
| Rate for Payer: Zelis Worker's Compensation |
$920.01
|
|
|
IR BX THYROID PERCUTANEOUS CORE NEED
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
7760100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$368.38 |
| Max. Negotiated Rate |
$1,761.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,112.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$465.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$368.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$1,112.40
|
| Rate for Payer: Cash Price |
$1,112.40
|
| Rate for Payer: Cigna Commercial |
$1,575.90
|
| Rate for Payer: First Health Commercial |
$1,668.60
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,668.60
|
| Rate for Payer: GEHA Commercial |
$1,483.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,668.60
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$375.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$1,687.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,297.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,668.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$434.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$375.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,761.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,390.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,724.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$741.60
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$607.96
|
|
|
IR BX THYROID PERCUTANEOUS CORE NEED
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
7760100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$506.14 |
| Max. Negotiated Rate |
$1,761.30 |
| Rate for Payer: Cash Price |
$1,112.40
|
| Rate for Payer: Cigna Commercial |
$1,575.90
|
| Rate for Payer: First Health Commercial |
$1,668.60
|
| Rate for Payer: First Health Workers Compensation |
$715.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,668.60
|
| Rate for Payer: GEHA Commercial |
$1,297.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,668.60
|
| Rate for Payer: Multiplan All |
$1,687.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,297.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,668.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,761.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,390.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,724.22
|
| Rate for Payer: Zelis Auto |
$741.60
|
| Rate for Payer: Zelis Worker's Compensation |
$506.14
|
|
|
IR CENTRAL VENOUS CATH PLACEMENT
|
Facility
|
IP
|
$3,480.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
7736556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$950.04 |
| Max. Negotiated Rate |
$3,306.00 |
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cigna Commercial |
$2,958.00
|
| Rate for Payer: First Health Commercial |
$3,132.00
|
| Rate for Payer: First Health Workers Compensation |
$1,343.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,132.00
|
| Rate for Payer: GEHA Commercial |
$2,436.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,132.00
|
| Rate for Payer: Multiplan All |
$3,166.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,436.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,132.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,306.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,610.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,236.40
|
| Rate for Payer: Zelis Auto |
$1,392.00
|
| Rate for Payer: Zelis Worker's Compensation |
$950.04
|
|
|
IR CENTRAL VENOUS CATH PLACEMENT
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
7736556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,088.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$894.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cash Price |
$2,088.00
|
| Rate for Payer: Cigna Commercial |
$2,958.00
|
| Rate for Payer: First Health Commercial |
$3,132.00
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,132.00
|
| Rate for Payer: GEHA Commercial |
$2,784.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,132.00
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$3,166.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,436.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,132.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,053.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,306.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$2,610.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,236.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$1,392.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$2,719.70
|
|
|
IR CHEST TUBE INSERTION
|
Facility
|
IP
|
$3,905.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
2432557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,066.07 |
| Max. Negotiated Rate |
$3,709.75 |
| Rate for Payer: Cash Price |
$2,343.00
|
| Rate for Payer: Cigna Commercial |
$3,319.25
|
| Rate for Payer: First Health Commercial |
$3,514.50
|
| Rate for Payer: First Health Workers Compensation |
$1,507.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,514.50
|
| Rate for Payer: GEHA Commercial |
$2,733.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,514.50
|
| Rate for Payer: Multiplan All |
$3,553.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,733.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,514.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,709.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,928.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,631.65
|
| Rate for Payer: Zelis Auto |
$1,562.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,066.07
|
|
|
IR CHEST TUBE INSERTION
|
Facility
|
OP
|
$3,905.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
2432557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$3,709.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,343.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$2,343.00
|
| Rate for Payer: Cash Price |
$2,343.00
|
| Rate for Payer: Cigna Commercial |
$3,319.25
|
| Rate for Payer: First Health Commercial |
$3,514.50
|
| Rate for Payer: First Health Workers Compensation |
$1,898.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,514.50
|
| Rate for Payer: GEHA Commercial |
$3,124.00
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,514.50
|
| 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 |
$472.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$3,553.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,733.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,514.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$545.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$472.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,709.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,928.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,631.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$1,562.00
|
| 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 |
$1,342.30
|
|
|
IR CONS SED E/AD 15 MIN
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
7799153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
IR CONS SED E/AD 15 MIN
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
7799153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
