|
IR DRAIN ABCESS RAD SUPERVISION ONLY
|
Facility
|
IP
|
$2,321.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
2407187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$2,204.95 |
| Rate for Payer: Cash Price |
$1,392.60
|
| Rate for Payer: Cash Price |
$1,392.60
|
| Rate for Payer: Cigna Commercial |
$1,972.85
|
| Rate for Payer: First Health Commercial |
$2,088.90
|
| Rate for Payer: First Health Workers Compensation |
$203.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,088.90
|
| Rate for Payer: GEHA Commercial |
$1,624.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,088.90
|
| Rate for Payer: Multiplan All |
$2,112.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,624.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,088.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,204.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,740.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,158.53
|
| Rate for Payer: Zelis Auto |
$928.40
|
| Rate for Payer: Zelis Worker's Compensation |
$144.01
|
|
|
IR DRAIN ABCESS RAD SUPERVISION ONLY
|
Facility
|
OP
|
$2,321.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
2407187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$2,204.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,392.60
|
| Rate for Payer: Cash Price |
$1,392.60
|
| Rate for Payer: Cash Price |
$1,392.60
|
| Rate for Payer: Cigna Commercial |
$1,972.85
|
| Rate for Payer: First Health Commercial |
$2,088.90
|
| Rate for Payer: First Health Workers Compensation |
$203.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,088.90
|
| Rate for Payer: GEHA Commercial |
$1,856.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,088.90
|
| Rate for Payer: Humana ChoiceCare |
$603.46
|
| Rate for Payer: Multiplan All |
$2,112.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,392.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,624.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,088.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,204.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,740.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,042.48
|
| Rate for Payer: United Healthcare Commercial |
$1,972.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$580.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,158.53
|
| Rate for Payer: Zelis Auto |
$928.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,160.50
|
| Rate for Payer: Zelis Worker's Compensation |
$144.01
|
|
|
IR DRAIN ABCESS W/CATH INSERTION
|
Facility
|
IP
|
$3,091.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
2407189
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.84 |
| Max. Negotiated Rate |
$2,936.45 |
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$2,627.35
|
| Rate for Payer: First Health Commercial |
$2,781.90
|
| Rate for Payer: First Health Workers Compensation |
$1,193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,781.90
|
| Rate for Payer: GEHA Commercial |
$2,163.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,781.90
|
| Rate for Payer: Multiplan All |
$2,812.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,163.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,781.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,936.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,318.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,874.63
|
| Rate for Payer: Zelis Auto |
$1,236.40
|
| Rate for Payer: Zelis Worker's Compensation |
$843.84
|
|
|
IR DRAIN ABCESS W/CATH INSERTION
|
Facility
|
OP
|
$3,091.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
2407189
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,236.40 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,701.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,854.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,701.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,348.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,569.98
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$2,627.35
|
| Rate for Payer: First Health Commercial |
$2,781.90
|
| Rate for Payer: First Health Workers Compensation |
$2,020.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,781.90
|
| Rate for Payer: GEHA Commercial |
$2,472.80
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,781.90
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,375.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$2,812.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,163.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,781.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,588.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,375.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,936.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,318.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,375.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,874.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$1,236.40
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$1,428.68
|
|
|
IR DRAIN PERC ABS PELVC
|
Facility
|
OP
|
$4,487.00
|
|
| Hospital Charge Code |
2407197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,121.75 |
| Max. Negotiated Rate |
$4,262.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,692.20
|
| Rate for Payer: Cash Price |
$2,692.20
|
| Rate for Payer: Cigna Commercial |
$3,813.95
|
| Rate for Payer: First Health Commercial |
$4,038.30
|
| Rate for Payer: First Health Workers Compensation |
$1,732.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,038.30
|
| Rate for Payer: GEHA Commercial |
$3,589.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,038.30
|
| Rate for Payer: Humana ChoiceCare |
$1,166.62
|
| Rate for Payer: Multiplan All |
$4,083.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,692.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,140.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,038.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,262.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,365.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,948.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,172.91
|
| Rate for Payer: Zelis Auto |
$1,794.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,243.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,224.95
|
|
|
IR DRAIN PERC ABS PELVC
|
Facility
|
IP
|
$4,487.00
|
|
| Hospital Charge Code |
2407197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,224.95 |
| Max. Negotiated Rate |
$4,262.65 |
| Rate for Payer: Cash Price |
$2,692.20
|
| Rate for Payer: Cigna Commercial |
$3,813.95
|
| Rate for Payer: First Health Commercial |
$4,038.30
|
| Rate for Payer: First Health Workers Compensation |
$1,732.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,038.30
|
| Rate for Payer: GEHA Commercial |
$3,140.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,038.30
|
| Rate for Payer: Multiplan All |
$4,083.17
|
| Rate for Payer: OMNI Networks Commercial |
$3,140.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,038.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,262.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,365.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,172.91
|
| Rate for Payer: Zelis Auto |
$1,794.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,224.95
|
|
|
IR DRAIN PERC LES LIVER
|
Facility
|
OP
|
$3,091.00
|
|
| Hospital Charge Code |
2407190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$772.75 |
| Max. Negotiated Rate |
$2,936.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,854.60
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$2,627.35
|
| Rate for Payer: First Health Commercial |
$2,781.90
|
| Rate for Payer: First Health Workers Compensation |
$1,193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,781.90
|
| Rate for Payer: GEHA Commercial |
$2,472.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,781.90
|
| Rate for Payer: Humana ChoiceCare |
$803.66
|
| Rate for Payer: Multiplan All |
$2,812.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,854.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,163.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,781.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,936.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,318.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,720.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$772.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,874.63
|
| Rate for Payer: Zelis Auto |
$1,236.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,545.50
|
| Rate for Payer: Zelis Worker's Compensation |
$843.84
|
|
|
IR DRAIN PERC LES LIVER
|
Facility
|
IP
|
$3,091.00
|
|
| Hospital Charge Code |
2407190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.84 |
| Max. Negotiated Rate |
$2,936.45 |
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$2,627.35
|
| Rate for Payer: First Health Commercial |
$2,781.90
|
| Rate for Payer: First Health Workers Compensation |
$1,193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,781.90
|
| Rate for Payer: GEHA Commercial |
$2,163.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,781.90
|
| Rate for Payer: Multiplan All |
$2,812.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,163.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,781.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,936.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,318.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,874.63
|
| Rate for Payer: Zelis Auto |
$1,236.40
|
| Rate for Payer: Zelis Worker's Compensation |
$843.84
|
|
|
IR DRAIN PERCUT LNG LES
|
Facility
|
OP
|
$2,509.00
|
|
| Hospital Charge Code |
2407188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$2,383.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,505.40
|
| Rate for Payer: Cash Price |
$1,505.40
|
| Rate for Payer: Cigna Commercial |
$2,132.65
|
| Rate for Payer: First Health Commercial |
$2,258.10
|
| Rate for Payer: First Health Workers Compensation |
$968.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,258.10
|
| Rate for Payer: GEHA Commercial |
$2,007.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,258.10
|
| Rate for Payer: Humana ChoiceCare |
$652.34
|
| Rate for Payer: Multiplan All |
$2,283.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,505.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,756.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,258.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,383.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,881.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,207.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$627.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,333.37
|
| Rate for Payer: Zelis Auto |
$1,003.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,254.50
|
| Rate for Payer: Zelis Worker's Compensation |
$684.96
|
|
|
IR DRAIN PERCUT LNG LES
|
Facility
|
IP
|
$2,509.00
|
|
| Hospital Charge Code |
2407188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.96 |
| Max. Negotiated Rate |
$2,383.55 |
| Rate for Payer: Cash Price |
$1,505.40
|
| Rate for Payer: Cigna Commercial |
$2,132.65
|
| Rate for Payer: First Health Commercial |
$2,258.10
|
| Rate for Payer: First Health Workers Compensation |
$968.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,258.10
|
| Rate for Payer: GEHA Commercial |
$1,756.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,258.10
|
| Rate for Payer: Multiplan All |
$2,283.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,756.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,258.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,383.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,881.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,333.37
|
| Rate for Payer: Zelis Auto |
$1,003.60
|
| Rate for Payer: Zelis Worker's Compensation |
$684.96
|
|
|
IR ESI CERV/THOR INJECTION
|
Facility
|
OP
|
$3,451.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
2462321
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$3,278.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$671.04
|
| Rate for Payer: Cash Price |
$2,070.60
|
| Rate for Payer: Cash Price |
$2,070.60
|
| Rate for Payer: Cigna Commercial |
$2,933.35
|
| Rate for Payer: First Health Commercial |
$3,105.90
|
| Rate for Payer: First Health Workers Compensation |
$1,332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.90
|
| Rate for Payer: GEHA Commercial |
$2,760.80
|
| Rate for Payer: GEHA Medicare |
$671.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.90
|
| Rate for Payer: Humana ChoiceCare |
$738.14
|
| Rate for Payer: Humana Medicare Advantage |
$671.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,127.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$671.04
|
| Rate for Payer: Multiplan All |
$3,140.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,140.77
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$671.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,278.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,342.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,588.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$657.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$671.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,209.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$671.04
|
| Rate for Payer: Zelis Auto |
$1,380.40
|
| Rate for Payer: Zelis Medicare |
$570.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$805.25
|
| Rate for Payer: Zelis Worker's Compensation |
$942.12
|
|
|
IR ESI CERV/THOR INJECTION
|
Facility
|
IP
|
$3,451.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
2462321
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$942.12 |
| Max. Negotiated Rate |
$3,278.45 |
| Rate for Payer: Cash Price |
$2,070.60
|
| Rate for Payer: Cigna Commercial |
$2,933.35
|
| Rate for Payer: First Health Commercial |
$3,105.90
|
| Rate for Payer: First Health Workers Compensation |
$1,332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.90
|
| Rate for Payer: GEHA Commercial |
$2,415.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.90
|
| Rate for Payer: Multiplan All |
$3,140.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,278.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,588.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,209.43
|
| Rate for Payer: Zelis Auto |
$1,380.40
|
| Rate for Payer: Zelis Worker's Compensation |
$942.12
|
|
|
IR ESI LUMBAR INJECTION
|
Facility
|
IP
|
$3,392.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
2462323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$926.02 |
| Max. Negotiated Rate |
$3,222.40 |
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Cigna Commercial |
$2,883.20
|
| Rate for Payer: First Health Commercial |
$3,052.80
|
| Rate for Payer: First Health Workers Compensation |
$1,309.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,052.80
|
| Rate for Payer: GEHA Commercial |
$2,374.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,052.80
|
| Rate for Payer: Multiplan All |
$3,086.72
|
| Rate for Payer: OMNI Networks Commercial |
$2,374.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,052.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,222.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,544.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,154.56
|
| Rate for Payer: Zelis Auto |
$1,356.80
|
| Rate for Payer: Zelis Worker's Compensation |
$926.02
|
|
|
IR ESI LUMBAR INJECTION
|
Facility
|
OP
|
$3,392.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
2462323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$3,222.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,035.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$671.04
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Cigna Commercial |
$2,883.20
|
| Rate for Payer: First Health Commercial |
$3,052.80
|
| Rate for Payer: First Health Workers Compensation |
$863.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,052.80
|
| Rate for Payer: GEHA Commercial |
$2,713.60
|
| Rate for Payer: GEHA Medicare |
$671.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,052.80
|
| Rate for Payer: Humana ChoiceCare |
$738.14
|
| Rate for Payer: Humana Medicare Advantage |
$671.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,127.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$671.04
|
| Rate for Payer: Multiplan All |
$3,086.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,140.77
|
| Rate for Payer: OMNI Networks Commercial |
$2,374.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,052.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$671.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,222.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,342.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,544.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$657.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$671.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,154.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$671.04
|
| Rate for Payer: Zelis Auto |
$1,356.80
|
| Rate for Payer: Zelis Medicare |
$570.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$805.25
|
| Rate for Payer: Zelis Worker's Compensation |
$610.65
|
|
|
IR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Facility
|
OP
|
$4,153.00
|
|
|
Service Code
|
CPT 49423
|
| Hospital Charge Code |
7749423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,226.34 |
| Max. Negotiated Rate |
$3,945.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,491.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,226.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,838.15
|
| Rate for Payer: Cash Price |
$2,491.80
|
| Rate for Payer: Cash Price |
$2,491.80
|
| Rate for Payer: Cigna Commercial |
$3,530.05
|
| Rate for Payer: First Health Commercial |
$3,737.70
|
| Rate for Payer: First Health Workers Compensation |
$2,365.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,737.70
|
| Rate for Payer: GEHA Commercial |
$3,322.40
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,737.70
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,251.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: Multiplan All |
$3,779.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,907.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,737.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,444.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,251.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,945.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,114.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,251.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,862.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Auto |
$1,661.20
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
| Rate for Payer: Zelis Worker's Compensation |
$1,672.72
|
|
|
IR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Facility
|
IP
|
$4,153.00
|
|
|
Service Code
|
CPT 49423
|
| Hospital Charge Code |
7749423
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,133.77 |
| Max. Negotiated Rate |
$3,945.35 |
| Rate for Payer: Cash Price |
$2,491.80
|
| Rate for Payer: Cigna Commercial |
$3,530.05
|
| Rate for Payer: First Health Commercial |
$3,737.70
|
| Rate for Payer: First Health Workers Compensation |
$1,603.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,737.70
|
| Rate for Payer: GEHA Commercial |
$2,907.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,737.70
|
| Rate for Payer: Multiplan All |
$3,779.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,907.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,737.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,945.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,862.29
|
| Rate for Payer: Zelis Auto |
$1,661.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,133.77
|
|
|
IR FINE NEEDLE ASP BX W/US GDN 1ST L
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
8233965
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$440.89 |
| Max. Negotiated Rate |
$1,534.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$969.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$688.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$681.76
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,372.75
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: First Health Workers Compensation |
$623.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,453.50
|
| Rate for Payer: GEHA Commercial |
$1,292.00
|
| Rate for Payer: GEHA Medicare |
$681.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,453.50
|
| Rate for Payer: Humana ChoiceCare |
$749.94
|
| Rate for Payer: Humana Medicare Advantage |
$681.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,145.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$702.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$681.76
|
| Rate for Payer: Multiplan All |
$1,469.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,158.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,130.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,453.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$811.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$702.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$681.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,534.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,363.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,211.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$668.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$702.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$681.76
|
| Rate for Payer: Zelis Auto |
$646.00
|
| Rate for Payer: Zelis Medicare |
$579.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$818.11
|
| Rate for Payer: Zelis Worker's Compensation |
$440.89
|
|
|
IR FINE NEEDLE ASP BX W/US GDN 1ST L
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
8233965
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$440.89 |
| Max. Negotiated Rate |
$1,534.25 |
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,372.75
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: First Health Workers Compensation |
$623.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,453.50
|
| Rate for Payer: GEHA Commercial |
$1,130.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,453.50
|
| Rate for Payer: Multiplan All |
$1,469.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,130.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,453.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,534.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.95
|
| Rate for Payer: Zelis Auto |
$646.00
|
| Rate for Payer: Zelis Worker's Compensation |
$440.89
|
|
|
IR FINE NEEDLE ASP BX W/US GDN EA AD
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
8233966
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
IR FINE NEEDLE ASP BX W/US GDN EA AD
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
8233966
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$646.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Humana ChoiceCare |
$210.08
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$484.80
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$711.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$202.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$404.00
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
IR FISTULA/SINUS TRAC STUDY
|
Facility
|
OP
|
$1,201.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
2400232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$1,140.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$315.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$720.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$315.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$249.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$531.29
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$1,020.85
|
| Rate for Payer: First Health Commercial |
$1,080.90
|
| Rate for Payer: First Health Workers Compensation |
$71.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,080.90
|
| Rate for Payer: GEHA Commercial |
$960.80
|
| Rate for Payer: GEHA Medicare |
$531.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,080.90
|
| Rate for Payer: Humana ChoiceCare |
$584.42
|
| Rate for Payer: Humana Medicare Advantage |
$531.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$892.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$254.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$531.29
|
| Rate for Payer: Multiplan All |
$1,092.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$903.19
|
| Rate for Payer: OMNI Networks Commercial |
$840.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,080.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$294.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$254.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$531.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,140.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,062.58
|
| Rate for Payer: Three Rivers Provider Network All |
$900.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$520.66
|
| Rate for Payer: United Healthcare Commercial |
$1,020.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$254.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$531.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,116.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$531.29
|
| Rate for Payer: Zelis Auto |
$480.40
|
| Rate for Payer: Zelis Medicare |
$451.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$637.55
|
| Rate for Payer: Zelis Worker's Compensation |
$50.89
|
|
|
IR FISTULA/SINUS TRAC STUDY
|
Facility
|
IP
|
$1,201.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
2400232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$1,140.95 |
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$1,020.85
|
| Rate for Payer: First Health Commercial |
$1,080.90
|
| Rate for Payer: First Health Workers Compensation |
$71.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,080.90
|
| Rate for Payer: GEHA Commercial |
$840.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,080.90
|
| Rate for Payer: Multiplan All |
$1,092.91
|
| Rate for Payer: OMNI Networks Commercial |
$840.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,140.95
|
| Rate for Payer: Three Rivers Provider Network All |
$900.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,116.93
|
| Rate for Payer: Zelis Auto |
$480.40
|
| Rate for Payer: Zelis Worker's Compensation |
$50.89
|
|
|
IR GB DRAIN CATH INSERTION W/IMAGING
|
Facility
|
OP
|
$6,629.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
7799218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,462.47 |
| Max. Negotiated Rate |
$6,839.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,977.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,462.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,419.59
|
| Rate for Payer: Cash Price |
$3,977.40
|
| Rate for Payer: Cash Price |
$3,977.40
|
| Rate for Payer: Cigna Commercial |
$5,634.65
|
| Rate for Payer: First Health Commercial |
$5,966.10
|
| Rate for Payer: First Health Workers Compensation |
$4,401.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,966.10
|
| Rate for Payer: GEHA Commercial |
$5,303.20
|
| Rate for Payer: GEHA Medicare |
$3,419.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,966.10
|
| Rate for Payer: Humana ChoiceCare |
$3,761.55
|
| Rate for Payer: Humana Medicare Advantage |
$3,419.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,744.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,512.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,419.59
|
| Rate for Payer: Multiplan All |
$6,032.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,813.30
|
| Rate for Payer: OMNI Networks Commercial |
$4,640.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,966.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,901.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,512.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,419.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,297.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,839.18
|
| Rate for Payer: Three Rivers Provider Network All |
$4,971.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,351.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,512.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,164.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,419.59
|
| Rate for Payer: Zelis Auto |
$2,651.60
|
| Rate for Payer: Zelis Medicare |
$2,906.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,103.51
|
| Rate for Payer: Zelis Worker's Compensation |
$3,111.83
|
|
|
IR GB DRAIN CATH INSERTION W/IMAGING
|
Facility
|
IP
|
$6,629.00
|
|
|
Service Code
|
CPT 47490
|
| Hospital Charge Code |
7799218
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,809.72 |
| Max. Negotiated Rate |
$6,297.55 |
| Rate for Payer: Cash Price |
$3,977.40
|
| Rate for Payer: Cigna Commercial |
$5,634.65
|
| Rate for Payer: First Health Commercial |
$5,966.10
|
| Rate for Payer: First Health Workers Compensation |
$2,559.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,966.10
|
| Rate for Payer: GEHA Commercial |
$4,640.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,966.10
|
| Rate for Payer: Multiplan All |
$6,032.39
|
| Rate for Payer: OMNI Networks Commercial |
$4,640.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,966.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,297.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,971.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,164.97
|
| Rate for Payer: Zelis Auto |
$2,651.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,809.72
|
|
|
IR GUIDED BREAST BIOPSY/W CLIP PLACEMENT
|
Facility
|
OP
|
$4,581.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
7719083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.82 |
| Max. Negotiated Rate |
$4,351.95 |
| 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 |
$2,748.60
|
| 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 |
$1,569.98
|
| Rate for Payer: Cash Price |
$2,748.60
|
| Rate for Payer: Cash Price |
$2,748.60
|
| Rate for Payer: Cigna Commercial |
$3,893.85
|
| Rate for Payer: First Health Commercial |
$4,122.90
|
| Rate for Payer: First Health Workers Compensation |
$2,020.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,122.90
|
| Rate for Payer: GEHA Commercial |
$3,664.80
|
| Rate for Payer: GEHA Medicare |
$1,569.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,122.90
|
| Rate for Payer: Humana ChoiceCare |
$1,726.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,569.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,637.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$789.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,569.98
|
| Rate for Payer: Multiplan All |
$4,168.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,668.97
|
| Rate for Payer: OMNI Networks Commercial |
$3,206.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,122.90
|
| 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 |
$1,569.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,351.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,139.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,435.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,538.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,260.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,569.98
|
| Rate for Payer: Zelis Auto |
$1,832.40
|
| Rate for Payer: Zelis Medicare |
$1,334.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,883.98
|
| Rate for Payer: Zelis Worker's Compensation |
$1,428.68
|
|
