|
IR PICC LINE PLACEMENT
|
Facility
|
OP
|
$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: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,640.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,444.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,640.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,299.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$2,444.40
|
| 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 |
$3,259.20
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,666.60
|
| 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 |
$1,326.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$3,707.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,851.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,666.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,531.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,326.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,870.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,055.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,326.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,788.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$1,629.60
|
| 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 |
$1,112.20
|
|
|
IR PLUERX CATH INSERTION
|
Facility
|
IP
|
$8,174.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
7732550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,231.50 |
| Max. Negotiated Rate |
$7,765.30 |
| Rate for Payer: Cash Price |
$4,904.40
|
| Rate for Payer: Cigna Commercial |
$6,947.90
|
| Rate for Payer: First Health Commercial |
$7,356.60
|
| Rate for Payer: First Health Workers Compensation |
$3,155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,356.60
|
| Rate for Payer: GEHA Commercial |
$5,721.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,356.60
|
| Rate for Payer: Multiplan All |
$7,438.34
|
| Rate for Payer: OMNI Networks Commercial |
$5,721.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,356.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,765.30
|
| Rate for Payer: Three Rivers Provider Network All |
$6,130.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,601.82
|
| Rate for Payer: Zelis Auto |
$3,269.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2,231.50
|
|
|
IR PLUERX CATH INSERTION
|
Facility
|
OP
|
$8,174.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
7732550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,439.82 |
| Max. Negotiated Rate |
$7,765.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,079.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,904.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,079.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,439.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$4,904.40
|
| Rate for Payer: Cash Price |
$4,904.40
|
| Rate for Payer: Cigna Commercial |
$6,947.90
|
| Rate for Payer: First Health Commercial |
$7,356.60
|
| Rate for Payer: First Health Workers Compensation |
$4,312.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,356.60
|
| Rate for Payer: GEHA Commercial |
$6,539.20
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,356.60
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,489.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$7,438.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$5,721.80
|
| Rate for Payer: One Health Plan PPO/POS |
$7,356.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,874.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,489.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,765.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$6,130.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,489.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,601.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$3,269.60
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3,049.39
|
|
|
IR PORT CHECK W/IMAGING
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
2436598
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.05 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$650.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: First Health Commercial |
$975.60
|
| Rate for Payer: First Health Workers Compensation |
$418.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$975.60
|
| Rate for Payer: GEHA Commercial |
$867.20
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$975.60
|
| Rate for Payer: Humana ChoiceCare |
$220.07
|
| Rate for Payer: Humana Medicare Advantage |
$200.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$336.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$986.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$758.80
|
| Rate for Payer: One Health Plan PPO/POS |
$975.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,029.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$813.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$921.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,008.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$433.60
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$295.93
|
|
|
IR PORT CHECK W/IMAGING
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
2436598
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.93 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: First Health Commercial |
$975.60
|
| Rate for Payer: First Health Workers Compensation |
$418.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$975.60
|
| Rate for Payer: GEHA Commercial |
$758.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$975.60
|
| Rate for Payer: Multiplan All |
$986.44
|
| Rate for Payer: OMNI Networks Commercial |
$758.80
|
| Rate for Payer: One Health Plan PPO/POS |
$975.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,029.80
|
| Rate for Payer: Three Rivers Provider Network All |
$813.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,008.12
|
| Rate for Payer: Zelis Auto |
$433.60
|
| Rate for Payer: Zelis Worker's Compensation |
$295.93
|
|
|
IR PRQ BRST LOC DVICE PLCMNT 1ST STRTCTC
|
Facility
|
OP
|
$3,626.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
7719283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.49 |
| Max. Negotiated Rate |
$3,444.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,175.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Cigna Commercial |
$3,082.10
|
| Rate for Payer: First Health Commercial |
$3,263.40
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,263.40
|
| Rate for Payer: GEHA Commercial |
$2,900.80
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,263.40
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$3,299.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$2,538.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,263.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,444.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,719.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,372.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,450.40
|
| 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 PRQ BRST LOC DVICE PLCMNT 1ST STRTCTC
|
Facility
|
IP
|
$3,626.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
7719283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$989.90 |
| Max. Negotiated Rate |
$3,444.70 |
| Rate for Payer: Cash Price |
$2,175.60
|
| Rate for Payer: Cigna Commercial |
$3,082.10
|
| Rate for Payer: First Health Commercial |
$3,263.40
|
| Rate for Payer: First Health Workers Compensation |
$1,400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,263.40
|
| Rate for Payer: GEHA Commercial |
$2,538.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,263.40
|
| Rate for Payer: Multiplan All |
$3,299.66
|
| Rate for Payer: OMNI Networks Commercial |
$2,538.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,263.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,444.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,719.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,372.18
|
| Rate for Payer: Zelis Auto |
$1,450.40
|
| Rate for Payer: Zelis Worker's Compensation |
$989.90
|
|
|
IR PRQ BRST LOC DVICE PLCMNT EA LES STRT
|
Facility
|
IP
|
$2,183.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
7719284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$595.96 |
| Max. Negotiated Rate |
$2,073.85 |
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$1,855.55
|
| Rate for Payer: First Health Commercial |
$1,964.70
|
| Rate for Payer: First Health Workers Compensation |
$842.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,964.70
|
| Rate for Payer: GEHA Commercial |
$1,528.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,964.70
|
| Rate for Payer: Multiplan All |
$1,986.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,528.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,964.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,073.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,637.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,030.19
|
| Rate for Payer: Zelis Auto |
$873.20
|
| Rate for Payer: Zelis Worker's Compensation |
$595.96
|
|
|
IR PRQ BRST LOC DVICE PLCMNT EA LES STRT
|
Facility
|
OP
|
$2,183.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
7719284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.96 |
| Max. Negotiated Rate |
$2,073.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,309.80
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$1,855.55
|
| Rate for Payer: First Health Commercial |
$1,964.70
|
| Rate for Payer: First Health Workers Compensation |
$540.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,964.70
|
| Rate for Payer: GEHA Commercial |
$1,746.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,964.70
|
| Rate for Payer: Humana ChoiceCare |
$567.58
|
| Rate for Payer: Multiplan All |
$1,986.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,309.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,528.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,964.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,073.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,637.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,921.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$545.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,030.19
|
| Rate for Payer: Zelis Auto |
$873.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,091.50
|
| Rate for Payer: Zelis Worker's Compensation |
$381.96
|
|
|
IR PRQ BRST LOC DVICE PLCMT 1ST LES MRI
|
Facility
|
OP
|
$4,235.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
7719287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.49 |
| Max. Negotiated Rate |
$4,023.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,541.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$2,541.00
|
| Rate for Payer: Cash Price |
$2,541.00
|
| Rate for Payer: Cigna Commercial |
$3,599.75
|
| Rate for Payer: First Health Commercial |
$3,811.50
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,811.50
|
| Rate for Payer: GEHA Commercial |
$3,388.00
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,811.50
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$3,853.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$2,964.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,811.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,023.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$3,176.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,938.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,694.00
|
| 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 PRQ BRST LOC DVICE PLCMT 1ST LES MRI
|
Facility
|
IP
|
$4,235.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
7719287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,156.15 |
| Max. Negotiated Rate |
$4,023.25 |
| Rate for Payer: Cash Price |
$2,541.00
|
| Rate for Payer: Cigna Commercial |
$3,599.75
|
| Rate for Payer: First Health Commercial |
$3,811.50
|
| Rate for Payer: First Health Workers Compensation |
$1,635.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,811.50
|
| Rate for Payer: GEHA Commercial |
$2,964.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,811.50
|
| Rate for Payer: Multiplan All |
$3,853.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,964.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,811.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,023.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,176.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,938.55
|
| Rate for Payer: Zelis Auto |
$1,694.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,156.15
|
|
|
IR PRQ BRST LOC DVICE PLCMT 1ST LES US G
|
Facility
|
OP
|
$2,898.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
7719285
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.49 |
| Max. Negotiated Rate |
$2,753.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,738.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$2,463.30
|
| Rate for Payer: First Health Commercial |
$2,608.20
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,608.20
|
| Rate for Payer: GEHA Commercial |
$2,318.40
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,608.20
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$2,637.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$2,028.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,608.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,753.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,173.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,695.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,159.20
|
| 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 PRQ BRST LOC DVICE PLCMT 1ST LES US G
|
Facility
|
IP
|
$2,898.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
7719285
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$791.15 |
| Max. Negotiated Rate |
$2,753.10 |
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$2,463.30
|
| Rate for Payer: First Health Commercial |
$2,608.20
|
| Rate for Payer: First Health Workers Compensation |
$1,118.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,608.20
|
| Rate for Payer: GEHA Commercial |
$2,028.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,608.20
|
| Rate for Payer: Multiplan All |
$2,637.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,028.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,608.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,753.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,173.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,695.14
|
| Rate for Payer: Zelis Auto |
$1,159.20
|
| Rate for Payer: Zelis Worker's Compensation |
$791.15
|
|
|
IR PRQ BRST LOC DVICE PLCMT EA LES MRI G
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
7719288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
IR PRQ BRST LOC DVICE PLCMT EA LES MRI G
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
7719288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$1,368.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$1,368.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$52.78
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$121.80
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.50
|
| Rate for Payer: Zelis Worker's Compensation |
$967.64
|
|
|
IR PRQ BRST LOC DVICE PLCMT EA LES US GD
|
Facility
|
OP
|
$2,083.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
7719286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.75 |
| Max. Negotiated Rate |
$1,978.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,249.80
|
| Rate for Payer: Cash Price |
$1,249.80
|
| Rate for Payer: Cash Price |
$1,249.80
|
| Rate for Payer: Cigna Commercial |
$1,770.55
|
| Rate for Payer: First Health Commercial |
$1,874.70
|
| Rate for Payer: First Health Workers Compensation |
$842.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,874.70
|
| Rate for Payer: GEHA Commercial |
$1,666.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,874.70
|
| Rate for Payer: Humana ChoiceCare |
$541.58
|
| Rate for Payer: Multiplan All |
$1,895.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,249.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,458.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,874.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,978.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,562.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,833.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,937.19
|
| Rate for Payer: Zelis Auto |
$833.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,041.50
|
| Rate for Payer: Zelis Worker's Compensation |
$595.86
|
|
|
IR PRQ BRST LOC DVICE PLCMT EA LES US GD
|
Facility
|
IP
|
$2,083.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
7719286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$568.66 |
| Max. Negotiated Rate |
$1,978.85 |
| Rate for Payer: Cash Price |
$1,249.80
|
| Rate for Payer: Cigna Commercial |
$1,770.55
|
| Rate for Payer: First Health Commercial |
$1,874.70
|
| Rate for Payer: First Health Workers Compensation |
$804.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,874.70
|
| Rate for Payer: GEHA Commercial |
$1,458.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,874.70
|
| Rate for Payer: Multiplan All |
$1,895.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,458.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,874.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,978.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,562.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,937.19
|
| Rate for Payer: Zelis Auto |
$833.20
|
| Rate for Payer: Zelis Worker's Compensation |
$568.66
|
|
|
IR PRQ DVICE PLCMNT BRST LOC 1ST LES MAM
|
Facility
|
IP
|
$2,939.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
7719281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$802.35 |
| Max. Negotiated Rate |
$2,792.05 |
| Rate for Payer: Cash Price |
$1,763.40
|
| Rate for Payer: Cigna Commercial |
$2,498.15
|
| Rate for Payer: First Health Commercial |
$2,645.10
|
| Rate for Payer: First Health Workers Compensation |
$1,134.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,645.10
|
| Rate for Payer: GEHA Commercial |
$2,057.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,645.10
|
| Rate for Payer: Multiplan All |
$2,674.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,057.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,645.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,792.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,204.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,733.27
|
| Rate for Payer: Zelis Auto |
$1,175.60
|
| Rate for Payer: Zelis Worker's Compensation |
$802.35
|
|
|
IR PRQ DVICE PLCMNT BRST LOC 1ST LES MAM
|
Facility
|
OP
|
$2,939.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
7719281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.49 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,763.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$1,763.40
|
| Rate for Payer: Cash Price |
$1,763.40
|
| Rate for Payer: Cigna Commercial |
$2,498.15
|
| Rate for Payer: First Health Commercial |
$2,645.10
|
| Rate for Payer: First Health Workers Compensation |
$1,980.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,645.10
|
| Rate for Payer: GEHA Commercial |
$2,351.20
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,645.10
|
| 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 |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$2,674.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,057.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,645.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,792.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$2,204.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,733.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$1,175.60
|
| 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 PRQ DVICE PLCMNT BRST LOC EA LES MAMO
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
7719282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.58 |
| Max. Negotiated Rate |
$2,042.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,290.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cigna Commercial |
$1,827.50
|
| Rate for Payer: First Health Commercial |
$1,935.00
|
| Rate for Payer: First Health Workers Compensation |
$488.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,935.00
|
| Rate for Payer: GEHA Commercial |
$1,720.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,935.00
|
| Rate for Payer: Humana ChoiceCare |
$559.00
|
| Rate for Payer: Multiplan All |
$1,956.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,290.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,505.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,935.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,042.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,612.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,892.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$537.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,999.50
|
| Rate for Payer: Zelis Auto |
$860.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,075.00
|
| Rate for Payer: Zelis Worker's Compensation |
$345.58
|
|
|
IR PRQ DVICE PLCMNT BRST LOC EA LES MAMO
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
7719282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$586.95 |
| Max. Negotiated Rate |
$2,042.50 |
| Rate for Payer: Cash Price |
$1,290.00
|
| Rate for Payer: Cigna Commercial |
$1,827.50
|
| Rate for Payer: First Health Commercial |
$1,935.00
|
| Rate for Payer: First Health Workers Compensation |
$830.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,935.00
|
| Rate for Payer: GEHA Commercial |
$1,505.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,935.00
|
| Rate for Payer: Multiplan All |
$1,956.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,505.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,935.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,042.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,612.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,999.50
|
| Rate for Payer: Zelis Auto |
$860.00
|
| Rate for Payer: Zelis Worker's Compensation |
$586.95
|
|
|
IR Removal tunneled CVC wo SQ port
|
Facility
|
OP
|
$2,906.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
7736589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$499.00 |
| Max. Negotiated Rate |
$2,760.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,743.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$579.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$1,743.60
|
| Rate for Payer: Cash Price |
$1,743.60
|
| Rate for Payer: Cigna Commercial |
$2,470.10
|
| Rate for Payer: First Health Commercial |
$2,615.40
|
| Rate for Payer: First Health Workers Compensation |
$755.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,615.40
|
| Rate for Payer: GEHA Commercial |
$2,324.80
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,615.40
|
| Rate for Payer: Humana ChoiceCare |
$645.77
|
| Rate for Payer: Humana Medicare Advantage |
$587.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$986.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$591.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$2,644.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,034.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,615.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$683.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$591.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,760.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,179.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$591.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,702.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$1,162.40
|
| Rate for Payer: Zelis Medicare |
$499.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.47
|
| Rate for Payer: Zelis Worker's Compensation |
$534.22
|
|
|
IR Removal tunneled CVC wo SQ port
|
Facility
|
IP
|
$2,906.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
7736589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.34 |
| Max. Negotiated Rate |
$2,760.70 |
| Rate for Payer: Cash Price |
$1,743.60
|
| Rate for Payer: Cigna Commercial |
$2,470.10
|
| Rate for Payer: First Health Commercial |
$2,615.40
|
| Rate for Payer: First Health Workers Compensation |
$1,122.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,615.40
|
| Rate for Payer: GEHA Commercial |
$2,034.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,615.40
|
| Rate for Payer: Multiplan All |
$2,644.46
|
| Rate for Payer: OMNI Networks Commercial |
$2,034.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,615.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,760.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,179.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,702.58
|
| Rate for Payer: Zelis Auto |
$1,162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$793.34
|
|
|
IR REMOVAL TUNNELED CVC WO SQ PORT
|
Facility
|
OP
|
$3,239.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
1999216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.00 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,943.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$579.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$2,753.15
|
| Rate for Payer: First Health Commercial |
$2,915.10
|
| Rate for Payer: First Health Workers Compensation |
$1,250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,915.10
|
| Rate for Payer: GEHA Commercial |
$2,591.20
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,915.10
|
| Rate for Payer: Humana ChoiceCare |
$645.77
|
| Rate for Payer: Humana Medicare Advantage |
$587.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$986.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$591.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$2,947.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,267.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,915.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$683.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$591.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,077.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,429.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$591.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,012.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$1,295.60
|
| Rate for Payer: Zelis Medicare |
$499.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.47
|
| Rate for Payer: Zelis Worker's Compensation |
$884.25
|
|
|
IR REMOVAL TUNNELED CVC WO SQ PORT
|
Facility
|
IP
|
$3,239.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
1999216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.25 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$2,753.15
|
| Rate for Payer: First Health Commercial |
$2,915.10
|
| Rate for Payer: First Health Workers Compensation |
$1,250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,915.10
|
| Rate for Payer: GEHA Commercial |
$2,267.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,915.10
|
| Rate for Payer: Multiplan All |
$2,947.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,267.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,915.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,077.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,429.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,012.27
|
| Rate for Payer: Zelis Auto |
$1,295.60
|
| Rate for Payer: Zelis Worker's Compensation |
$884.25
|
|
