|
NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
6193004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$588.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
6193004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
7662321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$441.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$588.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
7662321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
6162320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.36 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cigna Commercial |
$826.20
|
| Rate for Payer: First Health Commercial |
$874.80
|
| Rate for Payer: First Health Workers Compensation |
$375.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$874.80
|
| Rate for Payer: GEHA Commercial |
$777.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$874.80
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$884.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$680.40
|
| Rate for Payer: One Health Plan PPO/POS |
$874.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$923.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$729.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$388.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$265.36
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
6162320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.36 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cigna Commercial |
$826.20
|
| Rate for Payer: First Health Commercial |
$874.80
|
| Rate for Payer: First Health Workers Compensation |
$375.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$874.80
|
| Rate for Payer: GEHA Commercial |
$680.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$874.80
|
| Rate for Payer: Multiplan All |
$884.52
|
| Rate for Payer: OMNI Networks Commercial |
$680.40
|
| Rate for Payer: One Health Plan PPO/POS |
$874.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$923.40
|
| Rate for Payer: Three Rivers Provider Network All |
$729.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.96
|
| Rate for Payer: Zelis Auto |
$388.80
|
| Rate for Payer: Zelis Worker's Compensation |
$265.36
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
6162318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
21799469
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$190.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$134.86
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
7662310
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$568.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
7662310
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$497.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
6162310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$497.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
6162310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: First Health Workers Compensation |
$274.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$568.80
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$194.10
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
21999401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$190.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$134.86
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
21799469
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$190.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$395.20
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$134.86
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
6162318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
NJX DX/THER SBST INTRLMNR CRV/THRC W/O I
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
21999401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.86 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: First Health Workers Compensation |
$190.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$444.60
|
| Rate for Payer: GEHA Commercial |
$345.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$444.60
|
| Rate for Payer: Multiplan All |
$449.54
|
| Rate for Payer: OMNI Networks Commercial |
$345.80
|
| Rate for Payer: One Health Plan PPO/POS |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$469.30
|
| Rate for Payer: Three Rivers Provider Network All |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$459.42
|
| Rate for Payer: Zelis Auto |
$197.60
|
| Rate for Payer: Zelis Worker's Compensation |
$134.86
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
6162321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$252.45
|
| Rate for Payer: First Health Commercial |
$267.30
|
| Rate for Payer: First Health Workers Compensation |
$114.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$267.30
|
| Rate for Payer: GEHA Commercial |
$237.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$267.30
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$270.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$207.90
|
| Rate for Payer: One Health Plan PPO/POS |
$267.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$282.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$222.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$276.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$118.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$81.08
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
7662312
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
7662312
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
6162312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
6162312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
3701997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$341.20 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$846.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$598.40
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
6162321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$252.45
|
| Rate for Payer: First Health Commercial |
$267.30
|
| Rate for Payer: First Health Workers Compensation |
$114.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$267.30
|
| Rate for Payer: GEHA Commercial |
$207.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$267.30
|
| Rate for Payer: Multiplan All |
$270.27
|
| Rate for Payer: OMNI Networks Commercial |
$207.90
|
| Rate for Payer: One Health Plan PPO/POS |
$267.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$282.15
|
| Rate for Payer: Three Rivers Provider Network All |
$222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$276.21
|
| Rate for Payer: Zelis Auto |
$118.80
|
| Rate for Payer: Zelis Worker's Compensation |
$81.08
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
3701997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/O I
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
6162319
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$252.45
|
| Rate for Payer: First Health Commercial |
$267.30
|
| Rate for Payer: First Health Workers Compensation |
$114.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$267.30
|
| Rate for Payer: GEHA Commercial |
$207.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$267.30
|
| Rate for Payer: Multiplan All |
$270.27
|
| Rate for Payer: OMNI Networks Commercial |
$207.90
|
| Rate for Payer: One Health Plan PPO/POS |
$267.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$282.15
|
| Rate for Payer: Three Rivers Provider Network All |
$222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$276.21
|
| Rate for Payer: Zelis Auto |
$118.80
|
| Rate for Payer: Zelis Worker's Compensation |
$81.08
|
|
