|
IR NJX SBST INTRLMNR CRV/THRC W/IMG GDN
|
Facility
|
IP
|
$3,293.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
7762325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$898.99 |
| Max. Negotiated Rate |
$3,128.35 |
| Rate for Payer: Cash Price |
$1,975.80
|
| Rate for Payer: Cigna Commercial |
$2,799.05
|
| Rate for Payer: First Health Commercial |
$2,963.70
|
| Rate for Payer: First Health Workers Compensation |
$1,271.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,963.70
|
| Rate for Payer: GEHA Commercial |
$2,305.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,963.70
|
| Rate for Payer: Multiplan All |
$2,996.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,305.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,963.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,128.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,469.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,062.49
|
| Rate for Payer: Zelis Auto |
$1,317.20
|
| Rate for Payer: Zelis Worker's Compensation |
$898.99
|
|
|
IR NJX SBST INTRLMNR CRV/THRC W/IMG GDN
|
Facility
|
OP
|
$3,451.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
7762321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.94 |
| 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 |
$657.58
|
| 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 |
$846.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.90
|
| Rate for Payer: GEHA Commercial |
$2,760.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.90
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$3,140.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| 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 |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,278.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$2,588.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,209.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$1,380.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
IR NJX SBST INTRLMNR CRV/THRC W/IMG GDN
|
Facility
|
OP
|
$3,293.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
7762325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$3,128.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,975.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$1,975.80
|
| Rate for Payer: Cash Price |
$1,975.80
|
| Rate for Payer: Cigna Commercial |
$2,799.05
|
| Rate for Payer: First Health Commercial |
$2,963.70
|
| Rate for Payer: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,963.70
|
| Rate for Payer: GEHA Commercial |
$2,634.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,963.70
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$2,996.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,305.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,963.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,128.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,469.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,062.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$1,317.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$769.29
|
|
|
IR NJX SBST INTRLMNR CRV/THRC W/IMG GDN
|
Facility
|
IP
|
$3,451.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
7762321
|
|
Hospital Revenue Code
|
361
|
| 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 NJX SBST INTRLMNR CRV/THRC W/O IMG GD
|
Facility
|
OP
|
$3,393.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
7762324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$3,223.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,035.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$2,035.80
|
| Rate for Payer: Cash Price |
$2,035.80
|
| Rate for Payer: Cigna Commercial |
$2,884.05
|
| Rate for Payer: First Health Commercial |
$3,053.70
|
| Rate for Payer: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,053.70
|
| Rate for Payer: GEHA Commercial |
$2,714.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,053.70
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$3,087.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,375.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,053.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,223.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,544.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,155.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$1,357.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$769.29
|
|
|
IR NJX SBST INTRLMNR CRV/THRC W/O IMG GD
|
Facility
|
IP
|
$3,063.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
7762320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$836.20 |
| Max. Negotiated Rate |
$2,909.85 |
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cigna Commercial |
$2,603.55
|
| Rate for Payer: First Health Commercial |
$2,756.70
|
| Rate for Payer: First Health Workers Compensation |
$1,182.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,756.70
|
| Rate for Payer: GEHA Commercial |
$2,144.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,756.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,909.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,297.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,848.59
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$836.20
|
|
|
IR NJX SBST INTRLMNR CRV/THRC W/O IMG GD
|
Facility
|
IP
|
$3,393.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
7762324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$926.29 |
| Max. Negotiated Rate |
$3,223.35 |
| Rate for Payer: Cash Price |
$2,035.80
|
| Rate for Payer: Cigna Commercial |
$2,884.05
|
| Rate for Payer: First Health Commercial |
$3,053.70
|
| Rate for Payer: First Health Workers Compensation |
$1,310.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,053.70
|
| Rate for Payer: GEHA Commercial |
$2,375.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,053.70
|
| Rate for Payer: Multiplan All |
$3,087.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,375.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,053.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,223.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,544.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,155.49
|
| Rate for Payer: Zelis Auto |
$1,357.20
|
| Rate for Payer: Zelis Worker's Compensation |
$926.29
|
|
|
IR NJX SBST INTRLMNR CRV/THRC W/O IMG GD
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
7762320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.94 |
| Max. Negotiated Rate |
$2,909.85 |
| 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 |
$1,837.80
|
| 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 |
$657.58
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cigna Commercial |
$2,603.55
|
| Rate for Payer: First Health Commercial |
$2,756.70
|
| Rate for Payer: First Health Workers Compensation |
$846.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,756.70
|
| Rate for Payer: GEHA Commercial |
$2,450.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,756.70
|
| 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 |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,909.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$2,297.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,848.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
IR NJX SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
7762327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$3,561.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,249.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$2,249.40
|
| Rate for Payer: Cash Price |
$2,249.40
|
| Rate for Payer: Cigna Commercial |
$3,186.65
|
| Rate for Payer: First Health Commercial |
$3,374.10
|
| Rate for Payer: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,374.10
|
| Rate for Payer: GEHA Commercial |
$2,999.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,374.10
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$3,411.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,624.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,374.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,561.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,811.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,486.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$1,499.60
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$769.29
|
|
|
IR NJX SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
7762327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,023.48 |
| Max. Negotiated Rate |
$3,561.55 |
| Rate for Payer: Cash Price |
$2,249.40
|
| Rate for Payer: Cigna Commercial |
$3,186.65
|
| Rate for Payer: First Health Commercial |
$3,374.10
|
| Rate for Payer: First Health Workers Compensation |
$1,447.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,374.10
|
| Rate for Payer: GEHA Commercial |
$2,624.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,374.10
|
| Rate for Payer: Multiplan All |
$3,411.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,624.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,374.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,561.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,811.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,486.57
|
| Rate for Payer: Zelis Auto |
$1,499.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,023.48
|
|
|
IR NJX SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$3,392.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
7762323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.94 |
| 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 |
$657.58
|
| 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 |
$846.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,052.80
|
| Rate for Payer: GEHA Commercial |
$2,713.60
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,052.80
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$3,086.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| 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 |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,222.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$2,544.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,154.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$1,356.80
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
IR NJX SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$3,392.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
7762323
|
|
Hospital Revenue Code
|
361
|
| 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 NJX SBST INTRLMNR LMBR/SAC W/O IMG GD
|
Facility
|
IP
|
$4,712.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
7762326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,286.38 |
| Max. Negotiated Rate |
$4,476.40 |
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cigna Commercial |
$4,005.20
|
| Rate for Payer: First Health Commercial |
$4,240.80
|
| Rate for Payer: First Health Workers Compensation |
$1,819.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,240.80
|
| Rate for Payer: GEHA Commercial |
$3,298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,240.80
|
| Rate for Payer: Multiplan All |
$4,287.92
|
| Rate for Payer: OMNI Networks Commercial |
$3,298.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,240.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,476.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,534.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,382.16
|
| Rate for Payer: Zelis Auto |
$1,884.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,286.38
|
|
|
IR NJX SBST INTRLMNR LMBR/SAC W/O IMG GD
|
Facility
|
OP
|
$4,712.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
7762326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$4,476.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,827.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cigna Commercial |
$4,005.20
|
| Rate for Payer: First Health Commercial |
$4,240.80
|
| Rate for Payer: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,240.80
|
| Rate for Payer: GEHA Commercial |
$3,769.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,240.80
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$4,287.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$3,298.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,240.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,476.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$3,534.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,382.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$1,884.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$769.29
|
|
|
IR NJX SBST INTRLMNR LMBR/SAC W/O IMG GD
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7762322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$602.44 |
| Max. Negotiated Rate |
$3,393.40 |
| 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 |
$2,143.20
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$2,143.20
|
| Rate for Payer: Cash Price |
$2,143.20
|
| Rate for Payer: Cigna Commercial |
$3,036.20
|
| Rate for Payer: First Health Commercial |
$3,214.80
|
| Rate for Payer: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,214.80
|
| Rate for Payer: GEHA Commercial |
$2,857.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,214.80
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$3,250.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,500.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,214.80
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,393.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,679.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,321.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$1,428.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$769.29
|
|
|
IR NJX SBST INTRLMNR LMBR/SAC W/O IMG GD
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7762322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$975.16 |
| Max. Negotiated Rate |
$3,393.40 |
| Rate for Payer: Cash Price |
$2,143.20
|
| Rate for Payer: Cigna Commercial |
$3,036.20
|
| Rate for Payer: First Health Commercial |
$3,214.80
|
| Rate for Payer: First Health Workers Compensation |
$1,379.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,214.80
|
| Rate for Payer: GEHA Commercial |
$2,500.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,214.80
|
| Rate for Payer: Multiplan All |
$3,250.52
|
| Rate for Payer: OMNI Networks Commercial |
$2,500.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,214.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,393.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,679.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,321.96
|
| Rate for Payer: Zelis Auto |
$1,428.80
|
| Rate for Payer: Zelis Worker's Compensation |
$975.16
|
|
|
iron REF 001339
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
2232300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$12.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$75.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.51
|
|
|
iron REF 001339
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
2232300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$12.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.51
|
|
|
IRON (Vitros)
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
2232210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$12.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.51
|
|
|
IRON (Vitros)
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
2232210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$12.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$75.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.51
|
|
|
IR PERC NEEDLE BX MUSCLE
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
7720206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$625.93 |
| 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 |
$1,757.40
|
| 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 |
$1,757.40
|
| Rate for Payer: Cash Price |
$1,757.40
|
| Rate for Payer: Cigna Commercial |
$2,489.65
|
| Rate for Payer: First Health Commercial |
$2,636.10
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,636.10
|
| Rate for Payer: GEHA Commercial |
$2,343.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,636.10
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$638.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$2,665.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,050.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,636.10
|
| 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 |
$2,782.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,196.75
|
| 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 |
$2,723.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,171.60
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$1,400.02
|
|
|
IR PERC NEEDLE BX MUSCLE
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
7720206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$799.62 |
| Max. Negotiated Rate |
$2,782.55 |
| Rate for Payer: Cash Price |
$1,757.40
|
| Rate for Payer: Cigna Commercial |
$2,489.65
|
| Rate for Payer: First Health Commercial |
$2,636.10
|
| Rate for Payer: First Health Workers Compensation |
$1,130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,636.10
|
| Rate for Payer: GEHA Commercial |
$2,050.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,636.10
|
| Rate for Payer: Multiplan All |
$2,665.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,050.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,636.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,782.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,196.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,723.97
|
| Rate for Payer: Zelis Auto |
$1,171.60
|
| Rate for Payer: Zelis Worker's Compensation |
$799.62
|
|
|
IR PICC COMPLETE REPLACEMENT
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
7736584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
IR PICC COMPLETE REPLACEMENT
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
7736584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$2,950.10 |
| 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 |
$1,828.80
|
| 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 |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,898.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,438.40
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| 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 |
$2,773.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| 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 |
$2,895.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| 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 |
$2,834.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| 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 PICC LINE PLACEMENT
|
Facility
|
IP
|
$4,074.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2400111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,112.20 |
| Max. Negotiated Rate |
$3,870.30 |
| Rate for Payer: Cash Price |
$2,444.40
|
| Rate for Payer: Cigna Commercial |
$3,462.90
|
| Rate for Payer: First Health Commercial |
$3,666.60
|
| Rate for Payer: First Health Workers Compensation |
$1,572.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,666.60
|
| Rate for Payer: GEHA Commercial |
$2,851.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,666.60
|
| Rate for Payer: Multiplan All |
$3,707.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,851.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,666.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,870.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,055.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,788.82
|
| Rate for Payer: Zelis Auto |
$1,629.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,112.20
|
|
