|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/O I
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
6162319
|
|
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/O I
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
3701996
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/O I
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
3701996
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.80 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$1,087.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$681.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$769.29
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/O I
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
6162311
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/O I
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7662311
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$681.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$340.80
|
| 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 |
$232.60
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/O I
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
6162311
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$760.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$602.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$681.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$614.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$709.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$614.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$614.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$340.80
|
| 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 |
$232.60
|
|
|
NJX DX/THER SBST INTRLMNR LMBR/SAC W/O I
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
7662311
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
NJX DX/THE SBST INTRLM CRV/THR W/IMG GDN
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
6162323
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$254.15
|
| Rate for Payer: First Health Commercial |
$269.10
|
| Rate for Payer: First Health Workers Compensation |
$115.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$269.10
|
| Rate for Payer: GEHA Commercial |
$209.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$269.10
|
| Rate for Payer: Multiplan All |
$272.09
|
| Rate for Payer: OMNI Networks Commercial |
$209.30
|
| Rate for Payer: One Health Plan PPO/POS |
$269.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$284.05
|
| Rate for Payer: Three Rivers Provider Network All |
$224.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$278.07
|
| Rate for Payer: Zelis Auto |
$119.60
|
| Rate for Payer: Zelis Worker's Compensation |
$81.63
|
|
|
NJX DX/THE SBST INTRLM CRV/THR W/IMG GDN
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
6162327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$88.45 |
| 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 |
$194.40
|
| 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 |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$259.20
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| 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 |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| 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 |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| 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 |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
NJX DX/THE SBST INTRLM CRV/THR W/IMG GDN
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
6162325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$287.30
|
| Rate for Payer: First Health Commercial |
$304.20
|
| Rate for Payer: First Health Workers Compensation |
$130.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$304.20
|
| Rate for Payer: GEHA Commercial |
$236.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$304.20
|
| Rate for Payer: Multiplan All |
$307.58
|
| Rate for Payer: OMNI Networks Commercial |
$236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$321.10
|
| Rate for Payer: Three Rivers Provider Network All |
$253.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$314.34
|
| Rate for Payer: Zelis Auto |
$135.20
|
| Rate for Payer: Zelis Worker's Compensation |
$92.27
|
|
|
NJX DX/THE SBST INTRLM CRV/THR W/IMG GDN
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
6162323
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.63 |
| 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 |
$179.40
|
| 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 |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$254.15
|
| Rate for Payer: First Health Commercial |
$269.10
|
| Rate for Payer: First Health Workers Compensation |
$115.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$269.10
|
| Rate for Payer: GEHA Commercial |
$239.20
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$269.10
|
| 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 |
$272.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$209.30
|
| Rate for Payer: One Health Plan PPO/POS |
$269.10
|
| 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 |
$284.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$224.25
|
| 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 |
$278.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$119.60
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$81.63
|
|
|
NJX DX/THE SBST INTRLM CRV/THR W/IMG GDN
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
6162327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$275.40
|
| Rate for Payer: First Health Commercial |
$291.60
|
| Rate for Payer: First Health Workers Compensation |
$125.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$291.60
|
| Rate for Payer: GEHA Commercial |
$226.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: OMNI Networks Commercial |
$226.80
|
| Rate for Payer: One Health Plan PPO/POS |
$291.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
NJX DX/THE SBST INTRLM CRV/THR W/IMG GDN
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
6162325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.27 |
| 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 |
$202.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$287.30
|
| Rate for Payer: First Health Commercial |
$304.20
|
| Rate for Payer: First Health Workers Compensation |
$130.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$304.20
|
| Rate for Payer: GEHA Commercial |
$270.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$304.20
|
| 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 |
$307.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$304.20
|
| 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 |
$321.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$253.50
|
| 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 |
$314.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$135.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$92.27
|
|
|
NJX PLTLT PLASMA W/ IMAGING/HARVEST/PREP
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
9602320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.49 |
| Max. Negotiated Rate |
$2,172.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,372.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$1,372.20
|
| Rate for Payer: Cash Price |
$1,372.20
|
| Rate for Payer: Cigna Commercial |
$1,943.95
|
| Rate for Payer: First Health Commercial |
$2,058.30
|
| Rate for Payer: First Health Workers Compensation |
$883.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,058.30
|
| Rate for Payer: GEHA Commercial |
$1,829.60
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,058.30
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$2,081.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,600.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,058.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,172.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,715.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,126.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$914.80
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$624.35
|
|
|
NJX PLTLT PLASMA W/ IMAGING/HARVEST/PREP
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
9602320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.35 |
| Max. Negotiated Rate |
$2,172.65 |
| Rate for Payer: Cash Price |
$1,372.20
|
| Rate for Payer: Cigna Commercial |
$1,943.95
|
| Rate for Payer: First Health Commercial |
$2,058.30
|
| Rate for Payer: First Health Workers Compensation |
$883.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,058.30
|
| Rate for Payer: GEHA Commercial |
$1,600.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,058.30
|
| Rate for Payer: Multiplan All |
$2,081.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,600.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,058.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,172.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,126.91
|
| Rate for Payer: Zelis Auto |
$914.80
|
| Rate for Payer: Zelis Worker's Compensation |
$624.35
|
|
|
NJX PLTLT PLASMA W/IMG HARVEST/PREPARATI
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
8200232
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$462.46 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cigna Commercial |
$1,439.90
|
| Rate for Payer: First Health Commercial |
$1,524.60
|
| Rate for Payer: First Health Workers Compensation |
$654.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,524.60
|
| Rate for Payer: GEHA Commercial |
$1,185.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,524.60
|
| Rate for Payer: Multiplan All |
$1,541.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,524.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,609.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,270.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,575.42
|
| Rate for Payer: Zelis Auto |
$677.60
|
| Rate for Payer: Zelis Worker's Compensation |
$462.46
|
|
|
NJX PLTLT PLASMA W/IMG HARVEST/PREPARATI
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
6100232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
NJX PLTLT PLASMA W/IMG HARVEST/PREPARATI
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
8800232
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
NJX PLTLT PLASMA W/IMG HARVEST/PREPARATI
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
8800232
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
NJX PLTLT PLASMA W/IMG HARVEST/PREPARATI
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
8200232
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.49 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,016.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cigna Commercial |
$1,439.90
|
| Rate for Payer: First Health Commercial |
$1,524.60
|
| Rate for Payer: First Health Workers Compensation |
$654.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,524.60
|
| Rate for Payer: GEHA Commercial |
$1,355.20
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,524.60
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$1,541.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,524.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,609.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,270.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,575.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$677.60
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$462.46
|
|
|
NJX PLTLT PLASMA W/IMG HARVEST/PREPARATI
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
6100232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
NJX RETROGRADE URETHROCSTOGRAPY
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
6151610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
NJX RETROGRADE URETHROCSTOGRAPY
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
6151610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$51.48
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$118.80
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$174.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.00
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
NM BONE 3 PHASE
|
Facility
|
IP
|
$3,088.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2410021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$294.09 |
| Max. Negotiated Rate |
$2,933.60 |
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cigna Commercial |
$2,624.80
|
| Rate for Payer: First Health Commercial |
$2,779.20
|
| Rate for Payer: First Health Workers Compensation |
$415.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,779.20
|
| Rate for Payer: GEHA Commercial |
$2,161.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,779.20
|
| Rate for Payer: Multiplan All |
$2,810.08
|
| Rate for Payer: OMNI Networks Commercial |
$2,161.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,779.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,933.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,316.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,871.84
|
| Rate for Payer: Zelis Auto |
$1,235.20
|
| Rate for Payer: Zelis Worker's Compensation |
$294.09
|
|
|
NM BONE 3 PHASE
|
Facility
|
OP
|
$3,088.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2410021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$294.02 |
| Max. Negotiated Rate |
$2,933.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,852.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$294.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cigna Commercial |
$2,624.80
|
| Rate for Payer: First Health Commercial |
$2,779.20
|
| Rate for Payer: First Health Workers Compensation |
$415.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,779.20
|
| Rate for Payer: GEHA Commercial |
$2,470.40
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,779.20
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$300.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$2,810.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,161.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,779.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$346.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$300.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,933.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,316.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$2,624.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$300.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,871.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$1,235.20
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$294.09
|
|
