|
IR LYMPH NODE BX
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
2438505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.87 |
| Max. Negotiated Rate |
$2,710.35 |
| Rate for Payer: Cash Price |
$1,711.80
|
| Rate for Payer: Cigna Commercial |
$2,425.05
|
| Rate for Payer: First Health Commercial |
$2,567.70
|
| Rate for Payer: First Health Workers Compensation |
$1,101.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,567.70
|
| Rate for Payer: GEHA Commercial |
$1,997.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,567.70
|
| Rate for Payer: Multiplan All |
$2,596.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,997.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,567.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,710.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,139.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,653.29
|
| Rate for Payer: Zelis Auto |
$1,141.20
|
| Rate for Payer: Zelis Worker's Compensation |
$778.87
|
|
|
IR MID LINE CATHETER
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
2436410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.25 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$643.80
|
| Rate for Payer: Cash Price |
$643.80
|
| Rate for Payer: Cigna Commercial |
$912.05
|
| Rate for Payer: First Health Commercial |
$965.70
|
| Rate for Payer: First Health Workers Compensation |
$414.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$965.70
|
| Rate for Payer: GEHA Commercial |
$858.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$965.70
|
| Rate for Payer: Humana ChoiceCare |
$278.98
|
| Rate for Payer: Multiplan All |
$976.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$643.80
|
| Rate for Payer: OMNI Networks Commercial |
$751.10
|
| Rate for Payer: One Health Plan PPO/POS |
$965.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,019.35
|
| Rate for Payer: Three Rivers Provider Network All |
$804.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$944.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$997.89
|
| Rate for Payer: Zelis Auto |
$429.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$536.50
|
| Rate for Payer: Zelis Worker's Compensation |
$292.93
|
|
|
IR MID LINE CATHETER
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
2436410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.93 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Cash Price |
$643.80
|
| Rate for Payer: Cigna Commercial |
$912.05
|
| Rate for Payer: First Health Commercial |
$965.70
|
| Rate for Payer: First Health Workers Compensation |
$414.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$965.70
|
| Rate for Payer: GEHA Commercial |
$751.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$965.70
|
| Rate for Payer: Multiplan All |
$976.43
|
| Rate for Payer: OMNI Networks Commercial |
$751.10
|
| Rate for Payer: One Health Plan PPO/POS |
$965.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,019.35
|
| Rate for Payer: Three Rivers Provider Network All |
$804.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$997.89
|
| Rate for Payer: Zelis Auto |
$429.20
|
| Rate for Payer: Zelis Worker's Compensation |
$292.93
|
|
|
IR MOD SED 15 MINS
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
2499152
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$363.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
IR MOD SED 15 MINS
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
2499152
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$415.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Humana ChoiceCare |
$134.94
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$311.40
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$456.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$259.50
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
IR MOD SED ADDL 15 MI
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
2499153
|
|
Hospital Revenue Code
|
371
|
| 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
|
|
|
IR MOD SED ADDL 15 MI
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
2499153
|
|
Hospital Revenue Code
|
371
|
| 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 MOD SED SAME PHYS/QHP INITIAL 15 MINS
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
7799152
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$415.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Humana ChoiceCare |
$134.94
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$311.40
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$456.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$259.50
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
IR MOD SED SAME PHYS/QHP INITIAL 15 MINS
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
7799152
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$363.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
IR MYELOGRAM CERVICAL
|
Facility
|
OP
|
$3,461.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
2407202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$3,287.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$921.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,076.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$921.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$2,076.60
|
| Rate for Payer: Cash Price |
$2,076.60
|
| Rate for Payer: Cigna Commercial |
$2,941.85
|
| Rate for Payer: First Health Commercial |
$3,114.90
|
| Rate for Payer: First Health Workers Compensation |
$1,336.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.90
|
| Rate for Payer: GEHA Commercial |
$2,768.80
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.90
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$3,149.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$2,941.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,218.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,384.40
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$944.85
|
|
|
IR MYELOGRAM CERVICAL
|
Facility
|
IP
|
$3,461.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
2407202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$944.85 |
| Max. Negotiated Rate |
$3,287.95 |
| Rate for Payer: Cash Price |
$2,076.60
|
| Rate for Payer: Cigna Commercial |
$2,941.85
|
| Rate for Payer: First Health Commercial |
$3,114.90
|
| Rate for Payer: First Health Workers Compensation |
$1,336.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,114.90
|
| Rate for Payer: GEHA Commercial |
$2,422.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,114.90
|
| Rate for Payer: Multiplan All |
$3,149.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,422.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,114.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,287.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,595.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,218.73
|
| Rate for Payer: Zelis Auto |
$1,384.40
|
| Rate for Payer: Zelis Worker's Compensation |
$944.85
|
|
|
IR MYELOGRAM LUMBAR
|
Facility
|
OP
|
$3,517.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
2407204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$3,341.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$921.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,110.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$921.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$2,110.20
|
| Rate for Payer: Cash Price |
$2,110.20
|
| Rate for Payer: Cigna Commercial |
$2,989.45
|
| Rate for Payer: First Health Commercial |
$3,165.30
|
| Rate for Payer: First Health Workers Compensation |
$1,357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,165.30
|
| Rate for Payer: GEHA Commercial |
$2,813.60
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,165.30
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$3,200.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,461.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,165.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,341.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$2,637.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$2,989.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,270.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,406.80
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$960.14
|
|
|
IR MYELOGRAM LUMBAR
|
Facility
|
IP
|
$3,517.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
2407204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.14 |
| Max. Negotiated Rate |
$3,341.15 |
| Rate for Payer: Cash Price |
$2,110.20
|
| Rate for Payer: Cigna Commercial |
$2,989.45
|
| Rate for Payer: First Health Commercial |
$3,165.30
|
| Rate for Payer: First Health Workers Compensation |
$1,357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,165.30
|
| Rate for Payer: GEHA Commercial |
$2,461.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,165.30
|
| Rate for Payer: Multiplan All |
$3,200.47
|
| Rate for Payer: OMNI Networks Commercial |
$2,461.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,165.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,341.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,637.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,270.81
|
| Rate for Payer: Zelis Auto |
$1,406.80
|
| Rate for Payer: Zelis Worker's Compensation |
$960.14
|
|
|
IR MYELOGRAM THORACIC
|
Facility
|
OP
|
$3,204.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
2407203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$3,043.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$921.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,922.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$921.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$1,922.40
|
| Rate for Payer: Cash Price |
$1,922.40
|
| Rate for Payer: Cigna Commercial |
$2,723.40
|
| Rate for Payer: First Health Commercial |
$2,883.60
|
| Rate for Payer: First Health Workers Compensation |
$1,237.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,883.60
|
| Rate for Payer: GEHA Commercial |
$2,563.20
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,883.60
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$2,915.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,242.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,883.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,043.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$2,403.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$2,723.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,979.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,281.60
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$874.69
|
|
|
IR MYELOGRAM THORACIC
|
Facility
|
IP
|
$3,204.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
2407203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$874.69 |
| Max. Negotiated Rate |
$3,043.80 |
| Rate for Payer: Cash Price |
$1,922.40
|
| Rate for Payer: Cigna Commercial |
$2,723.40
|
| Rate for Payer: First Health Commercial |
$2,883.60
|
| Rate for Payer: First Health Workers Compensation |
$1,237.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,883.60
|
| Rate for Payer: GEHA Commercial |
$2,242.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,883.60
|
| Rate for Payer: Multiplan All |
$2,915.64
|
| Rate for Payer: OMNI Networks Commercial |
$2,242.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,883.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,043.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,403.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,979.72
|
| Rate for Payer: Zelis Auto |
$1,281.60
|
| Rate for Payer: Zelis Worker's Compensation |
$874.69
|
|
|
IR NEEDLE BIOPSY LYMPH NODES
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
6138505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$790.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$790.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$625.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| 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 |
$638.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$737.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$638.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$638.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$87.20
|
| 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 |
$59.51
|
|
|
IR NEEDLE BIOPSY LYMPH NODES
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
6138505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
IR NEPHROGRAM
|
Facility
|
IP
|
$3,023.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
2450431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$825.28 |
| Max. Negotiated Rate |
$2,871.85 |
| Rate for Payer: Cash Price |
$1,813.80
|
| Rate for Payer: Cigna Commercial |
$2,569.55
|
| Rate for Payer: First Health Commercial |
$2,720.70
|
| Rate for Payer: First Health Workers Compensation |
$1,167.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,720.70
|
| Rate for Payer: GEHA Commercial |
$2,116.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,720.70
|
| Rate for Payer: Multiplan All |
$2,750.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,116.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,720.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,871.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,267.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,811.39
|
| Rate for Payer: Zelis Auto |
$1,209.20
|
| Rate for Payer: Zelis Worker's Compensation |
$825.28
|
|
|
IR NEPHROGRAM
|
Facility
|
OP
|
$3,023.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
2450431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$538.72 |
| Max. Negotiated Rate |
$2,871.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$786.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,813.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$786.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$623.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$1,813.80
|
| Rate for Payer: Cash Price |
$1,813.80
|
| Rate for Payer: Cigna Commercial |
$2,569.55
|
| Rate for Payer: First Health Commercial |
$2,720.70
|
| Rate for Payer: First Health Workers Compensation |
$815.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,720.70
|
| Rate for Payer: GEHA Commercial |
$2,418.40
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,720.70
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$635.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$2,750.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$2,116.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,720.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$734.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$635.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,871.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$2,267.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$635.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,811.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$1,209.20
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$576.75
|
|
|
IR NEPHROSTOMY CATH EXCHANGE
|
Facility
|
OP
|
$3,629.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
2450435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.24 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$786.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,177.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$786.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$623.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$2,177.40
|
| Rate for Payer: Cash Price |
$2,177.40
|
| Rate for Payer: Cigna Commercial |
$3,084.65
|
| Rate for Payer: First Health Commercial |
$3,266.10
|
| Rate for Payer: First Health Workers Compensation |
$2,503.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,266.10
|
| Rate for Payer: GEHA Commercial |
$2,903.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,266.10
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$635.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$3,302.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$2,540.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,266.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$734.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$635.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,447.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$2,721.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$635.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,374.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$1,451.60
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,770.08
|
|
|
IR NEPHROSTOMY CATH EXCHANGE
|
Facility
|
IP
|
$3,629.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
2450435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$990.72 |
| Max. Negotiated Rate |
$3,447.55 |
| Rate for Payer: Cash Price |
$2,177.40
|
| Rate for Payer: Cigna Commercial |
$3,084.65
|
| Rate for Payer: First Health Commercial |
$3,266.10
|
| Rate for Payer: First Health Workers Compensation |
$1,401.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,266.10
|
| Rate for Payer: GEHA Commercial |
$2,540.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,266.10
|
| Rate for Payer: Multiplan All |
$3,302.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,540.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,266.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,447.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,721.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,374.97
|
| Rate for Payer: Zelis Auto |
$1,451.60
|
| Rate for Payer: Zelis Worker's Compensation |
$990.72
|
|
|
IR NEPHROSTOMY CATH PLACEMENT
|
Facility
|
IP
|
$7,257.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
2450432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,981.16 |
| Max. Negotiated Rate |
$6,894.15 |
| Rate for Payer: Cash Price |
$4,354.20
|
| Rate for Payer: Cigna Commercial |
$6,168.45
|
| Rate for Payer: First Health Commercial |
$6,531.30
|
| Rate for Payer: First Health Workers Compensation |
$2,801.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,531.30
|
| Rate for Payer: GEHA Commercial |
$5,079.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,531.30
|
| Rate for Payer: Multiplan All |
$6,603.87
|
| Rate for Payer: OMNI Networks Commercial |
$5,079.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,531.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,894.15
|
| Rate for Payer: Three Rivers Provider Network All |
$5,442.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,749.01
|
| Rate for Payer: Zelis Auto |
$2,902.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,981.16
|
|
|
IR NEPHROSTOMY CATH PLACEMENT
|
Facility
|
OP
|
$7,257.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
2450432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,653.37 |
| Max. Negotiated Rate |
$6,894.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,259.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,259.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,790.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$4,354.20
|
| Rate for Payer: Cash Price |
$4,354.20
|
| Rate for Payer: Cigna Commercial |
$6,168.45
|
| Rate for Payer: First Health Commercial |
$6,531.30
|
| Rate for Payer: First Health Workers Compensation |
$2,503.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,531.30
|
| Rate for Payer: GEHA Commercial |
$5,805.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,531.30
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,826.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$6,603.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$5,079.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,531.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,108.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,826.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,894.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$5,442.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,826.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,749.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$2,902.80
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,770.08
|
|
|
IR NJX RETROGRADE CYSTOGRAPHY/BLADR XR
|
Facility
|
IP
|
$1,726.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
7751610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$471.20 |
| Max. Negotiated Rate |
$1,639.70 |
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$1,467.10
|
| Rate for Payer: First Health Commercial |
$1,553.40
|
| Rate for Payer: First Health Workers Compensation |
$666.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,553.40
|
| Rate for Payer: GEHA Commercial |
$1,208.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,553.40
|
| Rate for Payer: Multiplan All |
$1,570.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,553.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,639.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,294.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,605.18
|
| Rate for Payer: Zelis Auto |
$690.40
|
| Rate for Payer: Zelis Worker's Compensation |
$471.20
|
|
|
IR NJX RETROGRADE CYSTOGRAPHY/BLADR XR
|
Facility
|
OP
|
$1,726.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
7751610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.10 |
| Max. Negotiated Rate |
$1,639.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,035.60
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$1,467.10
|
| Rate for Payer: First Health Commercial |
$1,553.40
|
| Rate for Payer: First Health Workers Compensation |
$373.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,553.40
|
| Rate for Payer: GEHA Commercial |
$1,380.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,553.40
|
| Rate for Payer: Humana ChoiceCare |
$448.76
|
| Rate for Payer: Multiplan All |
$1,570.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,035.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,553.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,639.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,294.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,518.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$431.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,605.18
|
| Rate for Payer: Zelis Auto |
$690.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$863.00
|
| Rate for Payer: Zelis Worker's Compensation |
$264.10
|
|
