|
IR GUIDED BREAST BIOPSY/W CLIP PLACEMENT
|
Facility
|
IP
|
$4,581.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
7719083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,250.61 |
| Max. Negotiated Rate |
$4,351.95 |
| 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 |
$1,768.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,122.90
|
| Rate for Payer: GEHA Commercial |
$3,206.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,122.90
|
| Rate for Payer: Multiplan All |
$4,168.71
|
| Rate for Payer: OMNI Networks Commercial |
$3,206.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,122.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,351.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,435.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,260.33
|
| Rate for Payer: Zelis Auto |
$1,832.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,250.61
|
|
|
IR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
2407246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$1,199.85 |
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: First Health Workers Compensation |
$116.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$884.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| Rate for Payer: Multiplan All |
$1,149.33
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,199.85
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,174.59
|
| Rate for Payer: Zelis Auto |
$505.20
|
| Rate for Payer: Zelis Worker's Compensation |
$82.66
|
|
|
IR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
2407246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$1,199.85 |
| 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 |
$757.80
|
| 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 |
$229.52
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: First Health Workers Compensation |
$116.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$1,010.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$254.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,149.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| 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 |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,199.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$254.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,174.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$505.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$82.66
|
|
|
IR IMAGE-GUIDED CATHETER PLACEMENT
|
Facility
|
IP
|
$2,984.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
2400114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.63 |
| Max. Negotiated Rate |
$2,834.80 |
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cigna Commercial |
$2,536.40
|
| Rate for Payer: First Health Commercial |
$2,685.60
|
| Rate for Payer: First Health Workers Compensation |
$1,152.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,685.60
|
| Rate for Payer: GEHA Commercial |
$2,088.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,685.60
|
| Rate for Payer: Multiplan All |
$2,715.44
|
| Rate for Payer: OMNI Networks Commercial |
$2,088.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,685.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,834.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,238.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,775.12
|
| Rate for Payer: Zelis Auto |
$1,193.60
|
| Rate for Payer: Zelis Worker's Compensation |
$814.63
|
|
|
IR IMAGE-GUIDED CATHETER PLACEMENT
|
Facility
|
OP
|
$2,984.00
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
2400114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.98 |
| Max. Negotiated Rate |
$2,834.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$222.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,790.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$222.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$175.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cigna Commercial |
$2,536.40
|
| Rate for Payer: First Health Commercial |
$2,685.60
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,685.60
|
| Rate for Payer: GEHA Commercial |
$2,387.20
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,685.60
|
| 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 |
$179.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$2,715.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$2,088.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,685.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$207.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$179.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,834.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,238.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$179.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,775.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,193.60
|
| 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 INJ/ASPIR FOR TRT BONE CYST(S)
|
Facility
|
IP
|
$3,961.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
7720615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,081.35 |
| Max. Negotiated Rate |
$3,762.95 |
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$3,366.85
|
| Rate for Payer: First Health Commercial |
$3,564.90
|
| Rate for Payer: First Health Workers Compensation |
$1,529.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,564.90
|
| Rate for Payer: GEHA Commercial |
$2,772.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,564.90
|
| Rate for Payer: Multiplan All |
$3,604.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,772.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,564.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,762.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,970.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,683.73
|
| Rate for Payer: Zelis Auto |
$1,584.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,081.35
|
|
|
IR INJ/ASPIR FOR TRT BONE CYST(S)
|
Facility
|
OP
|
$3,961.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
7720615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$368.38 |
| Max. Negotiated Rate |
$3,762.95 |
| 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 |
$2,376.60
|
| 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 |
$2,376.60
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$3,366.85
|
| Rate for Payer: First Health Commercial |
$3,564.90
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,564.90
|
| Rate for Payer: GEHA Commercial |
$3,168.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,564.90
|
| 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 |
$3,604.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$2,772.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,564.90
|
| 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 |
$3,762.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,970.75
|
| 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 |
$3,683.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,584.40
|
| 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 INJ/ASPIR OF GANGLION CYST(S) ANY LOC
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
7720612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$428.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
IR INJ/ASPIR OF GANGLION CYST(S) ANY LOC
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
7720612
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
|
IR INJECTION 1 TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
7799217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$1,506.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$951.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,268.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
IR INJECTION 1 TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
7799217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$1,506.70 |
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$612.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,110.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Worker's Compensation |
$432.98
|
|
|
IR INJECTION HIP ARTHROGRAPHY W/O ANESTH
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
2427093
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$273.25 |
| Max. Negotiated Rate |
$1,038.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: First Health Commercial |
$983.70
|
| Rate for Payer: First Health Workers Compensation |
$422.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$983.70
|
| Rate for Payer: GEHA Commercial |
$874.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$983.70
|
| Rate for Payer: Humana ChoiceCare |
$284.18
|
| Rate for Payer: Multiplan All |
$994.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$655.80
|
| Rate for Payer: OMNI Networks Commercial |
$765.10
|
| Rate for Payer: One Health Plan PPO/POS |
$983.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,038.35
|
| Rate for Payer: Three Rivers Provider Network All |
$819.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$961.84
|
| Rate for Payer: United Healthcare Commercial |
$929.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,016.49
|
| Rate for Payer: Zelis Auto |
$437.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$546.50
|
| Rate for Payer: Zelis Worker's Compensation |
$298.39
|
|
|
IR INJECTION HIP ARTHROGRAPHY W/O ANESTH
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
2427093
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$298.39 |
| Max. Negotiated Rate |
$1,038.35 |
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: First Health Commercial |
$983.70
|
| Rate for Payer: First Health Workers Compensation |
$422.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$983.70
|
| Rate for Payer: GEHA Commercial |
$765.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$983.70
|
| Rate for Payer: Multiplan All |
$994.63
|
| Rate for Payer: OMNI Networks Commercial |
$765.10
|
| Rate for Payer: One Health Plan PPO/POS |
$983.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,038.35
|
| Rate for Payer: Three Rivers Provider Network All |
$819.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,016.49
|
| Rate for Payer: Zelis Auto |
$437.20
|
| Rate for Payer: Zelis Worker's Compensation |
$298.39
|
|
|
IR INJECTION MAJOR JOINT W/OUT US GUI
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
7720610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$1,506.70 |
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$612.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,110.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Worker's Compensation |
$432.98
|
|
|
IR INJECTION MAJOR JOINT W/OUT US GUI
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
7720610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$1,506.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$951.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$1,348.10
|
| Rate for Payer: First Health Commercial |
$1,427.40
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,427.40
|
| Rate for Payer: GEHA Commercial |
$1,268.80
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,427.40
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$1,443.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,110.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,427.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,506.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,189.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,474.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$634.40
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
IR Insert Peripheral CVC (PICC) w/out SQ
|
Facility
|
OP
|
$3,656.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
7736568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$3,473.20 |
| 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 |
$2,193.60
|
| 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 |
$1,475.05
|
| Rate for Payer: Cash Price |
$2,193.60
|
| Rate for Payer: Cash Price |
$2,193.60
|
| Rate for Payer: Cigna Commercial |
$3,107.60
|
| Rate for Payer: First Health Commercial |
$3,290.40
|
| Rate for Payer: First Health Workers Compensation |
$1,898.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,290.40
|
| Rate for Payer: GEHA Commercial |
$2,924.80
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,290.40
|
| 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 |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$3,326.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,559.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,290.40
|
| 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 |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,473.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,742.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,400.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$1,462.40
|
| 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 |
$1,342.30
|
|
|
IR Insert Peripheral CVC (PICC) w/out SQ
|
Facility
|
IP
|
$3,656.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
7736568
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.09 |
| Max. Negotiated Rate |
$3,473.20 |
| Rate for Payer: Cash Price |
$2,193.60
|
| Rate for Payer: Cigna Commercial |
$3,107.60
|
| Rate for Payer: First Health Commercial |
$3,290.40
|
| Rate for Payer: First Health Workers Compensation |
$1,411.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,290.40
|
| Rate for Payer: GEHA Commercial |
$2,559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,290.40
|
| Rate for Payer: Multiplan All |
$3,326.96
|
| Rate for Payer: OMNI Networks Commercial |
$2,559.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,290.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,473.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,742.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,400.08
|
| Rate for Payer: Zelis Auto |
$1,462.40
|
| Rate for Payer: Zelis Worker's Compensation |
$998.09
|
|
|
IR Insert Peripheral CVC, w/SubQ port;5y
|
Facility
|
OP
|
$9,080.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
7736571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,029.25 |
| Max. Negotiated Rate |
$8,626.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,448.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,029.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$5,448.00
|
| Rate for Payer: Cash Price |
$5,448.00
|
| Rate for Payer: Cigna Commercial |
$7,718.00
|
| Rate for Payer: First Health Commercial |
$8,172.00
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,172.00
|
| Rate for Payer: GEHA Commercial |
$7,264.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,172.00
|
| 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 |
$2,070.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$8,262.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$6,356.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,172.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,390.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,070.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,626.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$6,810.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,444.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$3,632.00
|
| 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 Insert Peripheral CVC, w/SubQ port;5y
|
Facility
|
IP
|
$9,080.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
7736571
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,478.84 |
| Max. Negotiated Rate |
$8,626.00 |
| Rate for Payer: Cash Price |
$5,448.00
|
| Rate for Payer: Cigna Commercial |
$7,718.00
|
| Rate for Payer: First Health Commercial |
$8,172.00
|
| Rate for Payer: First Health Workers Compensation |
$3,505.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,172.00
|
| Rate for Payer: GEHA Commercial |
$6,356.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,172.00
|
| Rate for Payer: Multiplan All |
$8,262.80
|
| Rate for Payer: OMNI Networks Commercial |
$6,356.00
|
| Rate for Payer: One Health Plan PPO/POS |
$8,172.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,626.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,810.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,444.40
|
| Rate for Payer: Zelis Auto |
$3,632.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,478.84
|
|
|
IR Insert tunneled centrally CVC, w/o sq
|
Facility
|
OP
|
$7,666.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
7736558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,029.25 |
| Max. Negotiated Rate |
$7,282.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,599.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,029.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$4,599.60
|
| Rate for Payer: Cash Price |
$4,599.60
|
| Rate for Payer: Cigna Commercial |
$6,516.10
|
| Rate for Payer: First Health Commercial |
$6,899.40
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,899.40
|
| Rate for Payer: GEHA Commercial |
$6,132.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,899.40
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,070.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$6,976.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$5,366.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,899.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,390.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,070.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,282.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$5,749.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,129.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$3,066.40
|
| 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 Insert tunneled centrally CVC, w/o sq
|
Facility
|
IP
|
$7,666.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
7736558
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,092.82 |
| Max. Negotiated Rate |
$7,282.70 |
| Rate for Payer: Cash Price |
$4,599.60
|
| Rate for Payer: Cigna Commercial |
$6,516.10
|
| Rate for Payer: First Health Commercial |
$6,899.40
|
| Rate for Payer: First Health Workers Compensation |
$2,959.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,899.40
|
| Rate for Payer: GEHA Commercial |
$5,366.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,899.40
|
| Rate for Payer: Multiplan All |
$6,976.06
|
| Rate for Payer: OMNI Networks Commercial |
$5,366.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,899.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,282.70
|
| Rate for Payer: Three Rivers Provider Network All |
$5,749.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,129.38
|
| Rate for Payer: Zelis Auto |
$3,066.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,092.82
|
|
|
IR Insert tunneled centrally CVC, w/SubQ
|
Facility
|
IP
|
$8,926.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
7736561
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,436.80 |
| Max. Negotiated Rate |
$8,479.70 |
| Rate for Payer: Cash Price |
$5,355.60
|
| Rate for Payer: Cigna Commercial |
$7,587.10
|
| Rate for Payer: First Health Commercial |
$8,033.40
|
| Rate for Payer: First Health Workers Compensation |
$3,446.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,033.40
|
| Rate for Payer: GEHA Commercial |
$6,248.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,033.40
|
| Rate for Payer: Multiplan All |
$8,122.66
|
| Rate for Payer: OMNI Networks Commercial |
$6,248.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,033.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,479.70
|
| Rate for Payer: Three Rivers Provider Network All |
$6,694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,301.18
|
| Rate for Payer: Zelis Auto |
$3,570.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,436.80
|
|
|
IR Insert tunneled centrally CVC, w/SubQ
|
Facility
|
OP
|
$8,926.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
7736561
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,438.17 |
| Max. Negotiated Rate |
$8,479.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,355.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$5,355.60
|
| Rate for Payer: Cash Price |
$5,355.60
|
| Rate for Payer: Cigna Commercial |
$7,587.10
|
| Rate for Payer: First Health Commercial |
$8,033.40
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,033.40
|
| Rate for Payer: GEHA Commercial |
$7,140.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,033.40
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$8,122.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$6,248.20
|
| Rate for Payer: One Health Plan PPO/POS |
$8,033.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,479.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$6,694.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,301.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$3,570.40
|
| 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 Insert tunneled centrally CVS, w/SubQ
|
Facility
|
OP
|
$12,237.00
|
|
|
Service Code
|
CPT 36563
|
| Hospital Charge Code |
7736563
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,438.17 |
| Max. Negotiated Rate |
$11,625.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,342.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$7,342.20
|
| Rate for Payer: Cash Price |
$7,342.20
|
| Rate for Payer: Cigna Commercial |
$10,401.45
|
| Rate for Payer: First Health Commercial |
$11,013.30
|
| Rate for Payer: First Health Workers Compensation |
$6,606.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11,013.30
|
| Rate for Payer: GEHA Commercial |
$9,789.60
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11,013.30
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$11,135.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$8,565.90
|
| Rate for Payer: One Health Plan PPO/POS |
$11,013.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,625.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$9,177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,380.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$4,894.80
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$4,670.97
|
|
|
IR Insert tunneled centrally CVS, w/SubQ
|
Facility
|
IP
|
$12,237.00
|
|
|
Service Code
|
CPT 36563
|
| Hospital Charge Code |
7736563
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,340.70 |
| Max. Negotiated Rate |
$11,625.15 |
| Rate for Payer: Cash Price |
$7,342.20
|
| Rate for Payer: Cigna Commercial |
$10,401.45
|
| Rate for Payer: First Health Commercial |
$11,013.30
|
| Rate for Payer: First Health Workers Compensation |
$4,724.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11,013.30
|
| Rate for Payer: GEHA Commercial |
$8,565.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11,013.30
|
| Rate for Payer: Multiplan All |
$11,135.67
|
| Rate for Payer: OMNI Networks Commercial |
$8,565.90
|
| Rate for Payer: One Health Plan PPO/POS |
$11,013.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,625.15
|
| Rate for Payer: Three Rivers Provider Network All |
$9,177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,380.41
|
| Rate for Payer: Zelis Auto |
$4,894.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3,340.70
|
|
