|
IR Removal tunneled CVC wSQ port
|
Facility
|
IP
|
$5,097.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
7736590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,391.48 |
| Max. Negotiated Rate |
$4,842.15 |
| Rate for Payer: Cash Price |
$3,058.20
|
| Rate for Payer: Cigna Commercial |
$4,332.45
|
| Rate for Payer: First Health Commercial |
$4,587.30
|
| Rate for Payer: First Health Workers Compensation |
$1,967.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,587.30
|
| Rate for Payer: GEHA Commercial |
$3,567.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,587.30
|
| Rate for Payer: Multiplan All |
$4,638.27
|
| Rate for Payer: OMNI Networks Commercial |
$3,567.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,587.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,842.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,822.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,740.21
|
| Rate for Payer: Zelis Auto |
$2,038.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,391.48
|
|
|
IR Removal tunneled CVC wSQ port
|
Facility
|
OP
|
$5,097.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
7736590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,001.94 |
| Max. Negotiated Rate |
$4,842.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,264.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,058.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,264.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,001.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$3,058.20
|
| Rate for Payer: Cash Price |
$3,058.20
|
| Rate for Payer: Cigna Commercial |
$4,332.45
|
| Rate for Payer: First Health Commercial |
$4,587.30
|
| Rate for Payer: First Health Workers Compensation |
$1,898.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,587.30
|
| Rate for Payer: GEHA Commercial |
$4,077.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,587.30
|
| 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 |
$1,022.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$4,638.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$3,567.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,587.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,180.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,022.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,842.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,822.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,022.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,740.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$2,038.80
|
| 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 REM TUNNELED CVA W/SUBCUT PORT
|
Facility
|
OP
|
$5,097.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
7719289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,001.94 |
| Max. Negotiated Rate |
$4,842.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,264.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,058.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,264.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,001.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$3,058.20
|
| Rate for Payer: Cash Price |
$3,058.20
|
| Rate for Payer: Cigna Commercial |
$4,332.45
|
| Rate for Payer: First Health Commercial |
$4,587.30
|
| Rate for Payer: First Health Workers Compensation |
$1,898.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,587.30
|
| Rate for Payer: GEHA Commercial |
$4,077.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,587.30
|
| 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 |
$1,022.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$4,638.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$3,567.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,587.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,180.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,022.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,842.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,822.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,022.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,740.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$2,038.80
|
| 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 REM TUNNELED CVA W/SUBCUT PORT
|
Facility
|
IP
|
$5,097.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
7719289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,391.48 |
| Max. Negotiated Rate |
$4,842.15 |
| Rate for Payer: Cash Price |
$3,058.20
|
| Rate for Payer: Cigna Commercial |
$4,332.45
|
| Rate for Payer: First Health Commercial |
$4,587.30
|
| Rate for Payer: First Health Workers Compensation |
$1,967.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,587.30
|
| Rate for Payer: GEHA Commercial |
$3,567.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,587.30
|
| Rate for Payer: Multiplan All |
$4,638.27
|
| Rate for Payer: OMNI Networks Commercial |
$3,567.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,587.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,842.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,822.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,740.21
|
| Rate for Payer: Zelis Auto |
$2,038.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,391.48
|
|
|
IR Repair CVC, wo SQ port
|
Facility
|
IP
|
$2,357.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
7736575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$643.46 |
| Max. Negotiated Rate |
$2,239.15 |
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$2,003.45
|
| Rate for Payer: First Health Commercial |
$2,121.30
|
| Rate for Payer: First Health Workers Compensation |
$910.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,121.30
|
| Rate for Payer: GEHA Commercial |
$1,649.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,121.30
|
| Rate for Payer: Multiplan All |
$2,144.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,649.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,121.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,239.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,767.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,192.01
|
| Rate for Payer: Zelis Auto |
$942.80
|
| Rate for Payer: Zelis Worker's Compensation |
$643.46
|
|
|
IR Repair CVC, wo SQ port
|
Facility
|
OP
|
$2,357.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
7736575
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$499.00 |
| Max. Negotiated Rate |
$2,239.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,414.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$510.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$2,003.45
|
| Rate for Payer: First Health Commercial |
$2,121.30
|
| Rate for Payer: First Health Workers Compensation |
$755.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,121.30
|
| Rate for Payer: GEHA Commercial |
$1,885.60
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,121.30
|
| 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 |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$2,144.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,649.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,121.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$601.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$520.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,239.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,767.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,192.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$942.80
|
| 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 Repair CVC, w/SQ port/pump
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
7736576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$6,400.15 |
| 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 |
$4,042.20
|
| 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 |
$4,042.20
|
| Rate for Payer: Cash Price |
$4,042.20
|
| Rate for Payer: Cigna Commercial |
$5,726.45
|
| Rate for Payer: First Health Commercial |
$6,063.30
|
| Rate for Payer: First Health Workers Compensation |
$1,898.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,063.30
|
| Rate for Payer: GEHA Commercial |
$5,389.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,063.30
|
| 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 |
$6,130.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$4,715.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,063.30
|
| 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 |
$6,400.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,052.75
|
| 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 |
$6,265.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$2,694.80
|
| 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 Repair CVC, w/SQ port/pump
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
7736576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,839.20 |
| Max. Negotiated Rate |
$6,400.15 |
| Rate for Payer: Cash Price |
$4,042.20
|
| Rate for Payer: Cigna Commercial |
$5,726.45
|
| Rate for Payer: First Health Commercial |
$6,063.30
|
| Rate for Payer: First Health Workers Compensation |
$2,601.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,063.30
|
| Rate for Payer: GEHA Commercial |
$4,715.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,063.30
|
| Rate for Payer: Multiplan All |
$6,130.67
|
| Rate for Payer: OMNI Networks Commercial |
$4,715.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,063.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,400.15
|
| Rate for Payer: Three Rivers Provider Network All |
$5,052.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,265.41
|
| Rate for Payer: Zelis Auto |
$2,694.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,839.20
|
|
|
IR Replace CATH ONLY CVC device wSQ port
|
Facility
|
OP
|
$8,326.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
7736578
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,029.25 |
| Max. Negotiated Rate |
$7,909.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,995.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,029.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$4,995.60
|
| Rate for Payer: Cash Price |
$4,995.60
|
| Rate for Payer: Cigna Commercial |
$7,077.10
|
| Rate for Payer: First Health Commercial |
$7,493.40
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,493.40
|
| Rate for Payer: GEHA Commercial |
$6,660.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,493.40
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,070.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$7,576.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$5,828.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,493.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,390.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,070.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,909.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$6,244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,743.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$3,330.40
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$2,719.70
|
|
|
IR Replace CATH ONLY CVC device wSQ port
|
Facility
|
IP
|
$8,326.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
7736578
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,273.00 |
| Max. Negotiated Rate |
$7,909.70 |
| Rate for Payer: Cash Price |
$4,995.60
|
| Rate for Payer: Cigna Commercial |
$7,077.10
|
| Rate for Payer: First Health Commercial |
$7,493.40
|
| Rate for Payer: First Health Workers Compensation |
$3,214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,493.40
|
| Rate for Payer: GEHA Commercial |
$5,828.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,493.40
|
| Rate for Payer: Multiplan All |
$7,576.66
|
| Rate for Payer: OMNI Networks Commercial |
$5,828.20
|
| Rate for Payer: One Health Plan PPO/POS |
$7,493.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,909.70
|
| Rate for Payer: Three Rivers Provider Network All |
$6,244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,743.18
|
| Rate for Payer: Zelis Auto |
$3,330.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,273.00
|
|
|
IR Replacement nontunneled CVC wo SQ por
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
7736580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,382.20 |
| Max. Negotiated Rate |
$4,809.85 |
| Rate for Payer: Cash Price |
$3,037.80
|
| Rate for Payer: Cigna Commercial |
$4,303.55
|
| Rate for Payer: First Health Commercial |
$4,556.70
|
| Rate for Payer: First Health Workers Compensation |
$1,954.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,556.70
|
| Rate for Payer: GEHA Commercial |
$3,544.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,556.70
|
| Rate for Payer: Multiplan All |
$4,607.33
|
| Rate for Payer: OMNI Networks Commercial |
$3,544.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,556.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,809.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,797.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,708.59
|
| Rate for Payer: Zelis Auto |
$2,025.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,382.20
|
|
|
IR Replacement nontunneled CVC wo SQ por
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
7736580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$4,809.85 |
| 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 |
$3,037.80
|
| 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 |
$3,037.80
|
| Rate for Payer: Cash Price |
$3,037.80
|
| Rate for Payer: Cigna Commercial |
$4,303.55
|
| Rate for Payer: First Health Commercial |
$4,556.70
|
| Rate for Payer: First Health Workers Compensation |
$1,898.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,556.70
|
| Rate for Payer: GEHA Commercial |
$4,050.40
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,556.70
|
| 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 |
$4,607.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$3,544.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,556.70
|
| 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 |
$4,809.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,797.25
|
| 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 |
$4,708.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$2,025.20
|
| 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 Replacement periph CVC wSQ port
|
Facility
|
IP
|
$9,118.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
7736585
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,489.21 |
| Max. Negotiated Rate |
$8,662.10 |
| Rate for Payer: Cash Price |
$5,470.80
|
| Rate for Payer: Cigna Commercial |
$7,750.30
|
| Rate for Payer: First Health Commercial |
$8,206.20
|
| Rate for Payer: First Health Workers Compensation |
$3,520.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,206.20
|
| Rate for Payer: GEHA Commercial |
$6,382.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,206.20
|
| Rate for Payer: Multiplan All |
$8,297.38
|
| Rate for Payer: OMNI Networks Commercial |
$6,382.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,206.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,662.10
|
| Rate for Payer: Three Rivers Provider Network All |
$6,838.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,479.74
|
| Rate for Payer: Zelis Auto |
$3,647.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,489.21
|
|
|
IR Replacement periph CVC wSQ port
|
Facility
|
OP
|
$9,118.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
7736585
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,029.25 |
| Max. Negotiated Rate |
$8,662.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,470.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,029.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$5,470.80
|
| Rate for Payer: Cash Price |
$5,470.80
|
| Rate for Payer: Cigna Commercial |
$7,750.30
|
| Rate for Payer: First Health Commercial |
$8,206.20
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,206.20
|
| Rate for Payer: GEHA Commercial |
$7,294.40
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,206.20
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,070.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$8,297.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$6,382.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,206.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,390.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,070.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,662.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$6,838.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,479.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$3,647.20
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$2,719.70
|
|
|
IR Replacement tunneled CVC wo SQ port
|
Facility
|
IP
|
$6,845.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
7736581
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,868.68 |
| Max. Negotiated Rate |
$6,502.75 |
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$5,818.25
|
| Rate for Payer: First Health Commercial |
$6,160.50
|
| Rate for Payer: First Health Workers Compensation |
$2,642.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,160.50
|
| Rate for Payer: GEHA Commercial |
$4,791.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,160.50
|
| Rate for Payer: Multiplan All |
$6,228.95
|
| Rate for Payer: OMNI Networks Commercial |
$4,791.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,160.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,502.75
|
| Rate for Payer: Three Rivers Provider Network All |
$5,133.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,365.85
|
| Rate for Payer: Zelis Auto |
$2,738.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,868.68
|
|
|
IR Replacement tunneled CVC wo SQ port
|
Facility
|
OP
|
$6,845.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
7736581
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,029.25 |
| Max. Negotiated Rate |
$6,502.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,107.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,561.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,029.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$5,818.25
|
| Rate for Payer: First Health Commercial |
$6,160.50
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,160.50
|
| Rate for Payer: GEHA Commercial |
$5,476.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,160.50
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,070.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$6,228.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,791.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,160.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,390.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,070.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,502.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$5,133.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,365.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$2,738.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$2,719.70
|
|
|
IR Replacement tunneled CVC wSQ port
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
7736582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,712.26 |
| Max. Negotiated Rate |
$9,438.25 |
| Rate for Payer: Cash Price |
$5,961.00
|
| Rate for Payer: Cigna Commercial |
$8,444.75
|
| Rate for Payer: First Health Commercial |
$8,941.50
|
| Rate for Payer: First Health Workers Compensation |
$3,835.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,941.50
|
| Rate for Payer: GEHA Commercial |
$6,954.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,941.50
|
| Rate for Payer: Multiplan All |
$9,040.85
|
| Rate for Payer: OMNI Networks Commercial |
$6,954.50
|
| Rate for Payer: One Health Plan PPO/POS |
$8,941.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,438.25
|
| Rate for Payer: Three Rivers Provider Network All |
$7,451.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,239.55
|
| Rate for Payer: Zelis Auto |
$3,974.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,712.26
|
|
|
IR Replacement tunneled CVC wSQ port
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
7736582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,438.17 |
| Max. Negotiated Rate |
$9,438.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,961.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$5,961.00
|
| Rate for Payer: Cash Price |
$5,961.00
|
| Rate for Payer: Cigna Commercial |
$8,444.75
|
| Rate for Payer: First Health Commercial |
$8,941.50
|
| Rate for Payer: First Health Workers Compensation |
$3,846.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,941.50
|
| Rate for Payer: GEHA Commercial |
$7,948.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,941.50
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$9,040.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$6,954.50
|
| Rate for Payer: One Health Plan PPO/POS |
$8,941.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,438.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$7,451.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,239.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$3,974.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$2,719.70
|
|
|
IR Replacement tunneled CVC wSQ pump
|
Facility
|
IP
|
$13,996.00
|
|
|
Service Code
|
CPT 36583
|
| Hospital Charge Code |
7736583
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,820.91 |
| Max. Negotiated Rate |
$13,296.20 |
| Rate for Payer: Cash Price |
$8,397.60
|
| Rate for Payer: Cigna Commercial |
$11,896.60
|
| Rate for Payer: First Health Commercial |
$12,596.40
|
| Rate for Payer: First Health Workers Compensation |
$5,403.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,596.40
|
| Rate for Payer: GEHA Commercial |
$9,797.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,596.40
|
| Rate for Payer: Multiplan All |
$12,736.36
|
| Rate for Payer: OMNI Networks Commercial |
$9,797.20
|
| Rate for Payer: One Health Plan PPO/POS |
$12,596.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,296.20
|
| Rate for Payer: Three Rivers Provider Network All |
$10,497.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,016.28
|
| Rate for Payer: Zelis Auto |
$5,598.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3,820.91
|
|
|
IR Replacement tunneled CVC wSQ pump
|
Facility
|
OP
|
$13,996.00
|
|
|
Service Code
|
CPT 36583
|
| Hospital Charge Code |
7736583
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,438.17 |
| Max. Negotiated Rate |
$13,296.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,397.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$8,397.60
|
| Rate for Payer: Cash Price |
$8,397.60
|
| Rate for Payer: Cigna Commercial |
$11,896.60
|
| Rate for Payer: First Health Commercial |
$12,596.40
|
| Rate for Payer: First Health Workers Compensation |
$6,606.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,596.40
|
| Rate for Payer: GEHA Commercial |
$11,196.80
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,596.40
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$12,736.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$9,797.20
|
| Rate for Payer: One Health Plan PPO/POS |
$12,596.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,296.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$10,497.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,016.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$5,598.40
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$4,670.97
|
|
|
IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIV
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
1000049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIV
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
7896523
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIV
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
7896523
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Commercial |
$203.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
IRRIGATION MAXILLARY SINUS
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
6131000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$256.00
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
|
IRRIGATION MAXILLARY SINUS
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
6131000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
