|
PERMETHRIN CREAM 5%
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
3300703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.87 |
| Max. Negotiated Rate |
$479.75 |
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: First Health Commercial |
$454.50
|
| Rate for Payer: First Health Workers Compensation |
$194.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$454.50
|
| Rate for Payer: GEHA Commercial |
$353.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$454.50
|
| Rate for Payer: Multiplan All |
$459.55
|
| Rate for Payer: OMNI Networks Commercial |
$353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$454.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$479.75
|
| Rate for Payer: Three Rivers Provider Network All |
$378.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.65
|
| Rate for Payer: Zelis Auto |
$202.00
|
| Rate for Payer: Zelis Worker's Compensation |
$137.87
|
|
|
PERMETHRIN CREAM 5%
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
3300703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.25 |
| Max. Negotiated Rate |
$479.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$303.00
|
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: First Health Commercial |
$454.50
|
| Rate for Payer: First Health Workers Compensation |
$194.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$454.50
|
| Rate for Payer: GEHA Commercial |
$404.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$454.50
|
| Rate for Payer: Humana ChoiceCare |
$131.30
|
| Rate for Payer: Multiplan All |
$459.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$303.00
|
| Rate for Payer: OMNI Networks Commercial |
$353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$454.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$479.75
|
| Rate for Payer: Three Rivers Provider Network All |
$378.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$444.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.65
|
| Rate for Payer: Zelis Auto |
$202.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$252.50
|
| Rate for Payer: Zelis Worker's Compensation |
$137.87
|
|
|
PERQ CLSR TCAT L ATR APNDGE
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
6191067
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
PERQ CLSR TCAT L ATR APNDGE
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
6191067
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/O IMA
|
Facility
|
OP
|
$4,858.00
|
|
| Hospital Charge Code |
8132556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,214.50 |
| Max. Negotiated Rate |
$4,615.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,914.80
|
| Rate for Payer: Cash Price |
$2,914.80
|
| Rate for Payer: Cigna Commercial |
$4,129.30
|
| Rate for Payer: First Health Commercial |
$4,372.20
|
| Rate for Payer: First Health Workers Compensation |
$1,875.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,372.20
|
| Rate for Payer: GEHA Commercial |
$3,886.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,372.20
|
| Rate for Payer: Humana ChoiceCare |
$1,263.08
|
| Rate for Payer: Multiplan All |
$4,420.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,914.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,400.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,372.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,615.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,643.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,275.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,214.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,517.94
|
| Rate for Payer: Zelis Auto |
$1,943.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,429.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,326.23
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/O IMA
|
Facility
|
IP
|
$4,858.00
|
|
| Hospital Charge Code |
8132556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,326.23 |
| Max. Negotiated Rate |
$4,615.10 |
| Rate for Payer: Cash Price |
$2,914.80
|
| Rate for Payer: Cigna Commercial |
$4,129.30
|
| Rate for Payer: First Health Commercial |
$4,372.20
|
| Rate for Payer: First Health Workers Compensation |
$1,875.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,372.20
|
| Rate for Payer: GEHA Commercial |
$3,400.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,372.20
|
| Rate for Payer: Multiplan All |
$4,420.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,400.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,372.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,615.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,643.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,517.94
|
| Rate for Payer: Zelis Auto |
$1,943.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,326.23
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/O IMA
|
Facility
|
OP
|
$1,637.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
6132556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$446.90 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$982.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$982.20
|
| Rate for Payer: Cash Price |
$982.20
|
| Rate for Payer: Cigna Commercial |
$1,391.45
|
| Rate for Payer: First Health Commercial |
$1,473.30
|
| Rate for Payer: First Health Workers Compensation |
$632.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,473.30
|
| Rate for Payer: GEHA Commercial |
$1,309.60
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,473.30
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$472.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$1,489.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,145.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,473.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$545.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$472.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,555.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,227.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,522.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$654.80
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$446.90
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/O IMA
|
Facility
|
IP
|
$4,479.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
10032556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,222.77 |
| Max. Negotiated Rate |
$4,255.05 |
| Rate for Payer: Cash Price |
$2,687.40
|
| Rate for Payer: Cigna Commercial |
$3,807.15
|
| Rate for Payer: First Health Commercial |
$4,031.10
|
| Rate for Payer: First Health Workers Compensation |
$1,729.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,031.10
|
| Rate for Payer: GEHA Commercial |
$3,135.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,031.10
|
| Rate for Payer: Multiplan All |
$4,075.89
|
| Rate for Payer: OMNI Networks Commercial |
$3,135.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,031.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,255.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,359.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,165.47
|
| Rate for Payer: Zelis Auto |
$1,791.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,222.77
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/O IMA
|
Facility
|
IP
|
$1,637.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
6132556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$446.90 |
| Max. Negotiated Rate |
$1,555.15 |
| Rate for Payer: Cash Price |
$982.20
|
| Rate for Payer: Cigna Commercial |
$1,391.45
|
| Rate for Payer: First Health Commercial |
$1,473.30
|
| Rate for Payer: First Health Workers Compensation |
$632.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,473.30
|
| Rate for Payer: GEHA Commercial |
$1,145.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,473.30
|
| Rate for Payer: Multiplan All |
$1,489.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,145.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,473.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,555.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,227.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,522.41
|
| Rate for Payer: Zelis Auto |
$654.80
|
| Rate for Payer: Zelis Worker's Compensation |
$446.90
|
|
|
PERQ REPLACEMENT GTUBE REQ REVJ GSTRST T
|
Facility
|
IP
|
$1,403.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
1999226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.02 |
| Max. Negotiated Rate |
$1,332.85 |
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: First Health Workers Compensation |
$541.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$982.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: Zelis Auto |
$561.20
|
| Rate for Payer: Zelis Worker's Compensation |
$383.02
|
|
|
PERQ REPLACEMENT GTUBE REQ REVJ GSTRST T
|
Facility
|
OP
|
$1,403.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
1999226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$1,332.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: First Health Workers Compensation |
$541.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$1,122.40
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$280.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$280.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$561.20
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$383.02
|
|
|
PERQ REPLACEMENT GTUBE REQ REVJ GSTRST T
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
20399227
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$917.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$579.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$821.10
|
| Rate for Payer: First Health Commercial |
$869.40
|
| Rate for Payer: First Health Workers Compensation |
$372.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$869.40
|
| Rate for Payer: GEHA Commercial |
$772.80
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$280.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$879.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$676.20
|
| Rate for Payer: One Health Plan PPO/POS |
$869.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$280.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$917.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$724.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$898.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$386.40
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$263.72
|
|
|
PERQ REPLACEMENT GTUBE REQ REVJ GSTRST T
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
8143763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.48 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$913.75
|
| Rate for Payer: First Health Commercial |
$967.50
|
| Rate for Payer: First Health Workers Compensation |
$415.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$967.50
|
| Rate for Payer: GEHA Commercial |
$752.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$967.50
|
| Rate for Payer: Multiplan All |
$978.25
|
| Rate for Payer: OMNI Networks Commercial |
$752.50
|
| Rate for Payer: One Health Plan PPO/POS |
$967.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,021.25
|
| Rate for Payer: Three Rivers Provider Network All |
$806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$999.75
|
| Rate for Payer: Zelis Auto |
$430.00
|
| Rate for Payer: Zelis Worker's Compensation |
$293.48
|
|
|
PERQ REPLACEMENT GTUBE REQ REVJ GSTRST T
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
1002005
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$293.48 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$913.75
|
| Rate for Payer: First Health Commercial |
$967.50
|
| Rate for Payer: First Health Workers Compensation |
$415.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$967.50
|
| Rate for Payer: GEHA Commercial |
$752.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$967.50
|
| Rate for Payer: Multiplan All |
$978.25
|
| Rate for Payer: OMNI Networks Commercial |
$752.50
|
| Rate for Payer: One Health Plan PPO/POS |
$967.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,021.25
|
| Rate for Payer: Three Rivers Provider Network All |
$806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$999.75
|
| Rate for Payer: Zelis Auto |
$430.00
|
| Rate for Payer: Zelis Worker's Compensation |
$293.48
|
|
|
PERQ REPLACEMENT GTUBE REQ REVJ GSTRST T
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
20399227
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$263.72 |
| Max. Negotiated Rate |
$917.70 |
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$821.10
|
| Rate for Payer: First Health Commercial |
$869.40
|
| Rate for Payer: First Health Workers Compensation |
$372.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$869.40
|
| Rate for Payer: GEHA Commercial |
$676.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$869.40
|
| Rate for Payer: Multiplan All |
$879.06
|
| Rate for Payer: OMNI Networks Commercial |
$676.20
|
| Rate for Payer: One Health Plan PPO/POS |
$869.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$917.70
|
| Rate for Payer: Three Rivers Provider Network All |
$724.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$898.38
|
| Rate for Payer: Zelis Auto |
$386.40
|
| Rate for Payer: Zelis Worker's Compensation |
$263.72
|
|
|
PERQ REPLACEMENT GTUBE REQ REVJ GSTRST T
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT 43763
|
| Hospital Charge Code |
8143763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$913.75
|
| Rate for Payer: First Health Commercial |
$967.50
|
| Rate for Payer: First Health Workers Compensation |
$415.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$967.50
|
| Rate for Payer: GEHA Commercial |
$860.00
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$967.50
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$280.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$978.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$752.50
|
| Rate for Payer: One Health Plan PPO/POS |
$967.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$280.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,021.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$806.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$999.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$430.00
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$293.48
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
8143762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$602.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
OP
|
$1,304.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
1999225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$1,238.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$1,108.40
|
| Rate for Payer: First Health Commercial |
$1,173.60
|
| Rate for Payer: First Health Workers Compensation |
$503.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,173.60
|
| Rate for Payer: GEHA Commercial |
$1,043.20
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,173.60
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$280.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$1,186.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$912.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,173.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$280.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,238.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$978.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,212.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$521.60
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$355.99
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
6143762
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
8143762
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.30 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$516.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$688.00
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$280.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$280.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
20399226
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$551.65
|
| Rate for Payer: First Health Commercial |
$584.10
|
| Rate for Payer: First Health Workers Compensation |
$250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$584.10
|
| Rate for Payer: GEHA Commercial |
$454.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$584.10
|
| Rate for Payer: Multiplan All |
$590.59
|
| Rate for Payer: OMNI Networks Commercial |
$454.30
|
| Rate for Payer: One Health Plan PPO/POS |
$584.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$616.55
|
| Rate for Payer: Three Rivers Provider Network All |
$486.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$603.57
|
| Rate for Payer: Zelis Auto |
$259.60
|
| Rate for Payer: Zelis Worker's Compensation |
$177.18
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
IP
|
$1,304.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
1999225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.99 |
| Max. Negotiated Rate |
$1,238.80 |
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$1,108.40
|
| Rate for Payer: First Health Commercial |
$1,173.60
|
| Rate for Payer: First Health Workers Compensation |
$503.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,173.60
|
| Rate for Payer: GEHA Commercial |
$912.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,173.60
|
| Rate for Payer: Multiplan All |
$1,186.64
|
| Rate for Payer: OMNI Networks Commercial |
$912.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,173.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,238.80
|
| Rate for Payer: Three Rivers Provider Network All |
$978.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,212.72
|
| Rate for Payer: Zelis Auto |
$521.60
|
| Rate for Payer: Zelis Worker's Compensation |
$355.99
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
1002004
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$234.78 |
| Max. Negotiated Rate |
$817.00 |
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$731.00
|
| Rate for Payer: First Health Commercial |
$774.00
|
| Rate for Payer: First Health Workers Compensation |
$332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.00
|
| Rate for Payer: GEHA Commercial |
$602.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.00
|
| Rate for Payer: Multiplan All |
$782.60
|
| Rate for Payer: OMNI Networks Commercial |
$602.00
|
| Rate for Payer: One Health Plan PPO/POS |
$774.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.00
|
| Rate for Payer: Three Rivers Provider Network All |
$645.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$799.80
|
| Rate for Payer: Zelis Auto |
$344.00
|
| Rate for Payer: Zelis Worker's Compensation |
$234.78
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
6143762
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$280.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$280.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
PERQ REPLC GTUBE NOT REQ REVJ GSTRST TRC
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
20399226
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$347.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$275.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$551.65
|
| Rate for Payer: First Health Commercial |
$584.10
|
| Rate for Payer: First Health Workers Compensation |
$250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$584.10
|
| Rate for Payer: GEHA Commercial |
$519.20
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$584.10
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$280.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$590.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$454.30
|
| Rate for Payer: One Health Plan PPO/POS |
$584.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$280.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$616.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$486.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$603.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$259.60
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$177.18
|
|
