|
PROCAINAMIDE HCL INJ 100MG/ML
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
3300760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$589.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$294.69
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$324.16
|
| Rate for Payer: GEHA Medicare |
$294.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$324.16
|
| Rate for Payer: Humana Medicare Advantage |
$294.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$495.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$294.69
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$500.97
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$294.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$589.38
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$288.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$294.69
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Medicare |
$250.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$353.63
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
PROCAINAMIDE HCL INJ 100MG/ML
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT J2690
|
| Hospital Charge Code |
3300760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
procalcitonin REF164750
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
2200572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$40.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$231.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.80
|
|
|
procalcitonin REF164750
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
2200572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$48.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27.22
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$40.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$264.80
|
| Rate for Payer: GEHA Medicare |
$27.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Humana ChoiceCare |
$29.94
|
| Rate for Payer: Humana Medicare Advantage |
$27.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$39.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27.22
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$46.27
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$39.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$54.44
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.68
|
| Rate for Payer: United Healthcare Commercial |
$281.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$27.22
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Medicare |
$23.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.66
|
| Rate for Payer: Zelis Worker's Compensation |
$28.80
|
|
|
PROCALCITONIN (Vitros)
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
2232273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$40.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$231.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.80
|
|
|
PROCALCITONIN (Vitros)
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
2232273
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$48.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27.22
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$281.35
|
| Rate for Payer: First Health Commercial |
$297.90
|
| Rate for Payer: First Health Workers Compensation |
$40.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.90
|
| Rate for Payer: GEHA Commercial |
$264.80
|
| Rate for Payer: GEHA Medicare |
$27.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.90
|
| Rate for Payer: Humana ChoiceCare |
$29.94
|
| Rate for Payer: Humana Medicare Advantage |
$27.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$39.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27.22
|
| Rate for Payer: Multiplan All |
$301.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$46.27
|
| Rate for Payer: OMNI Networks Commercial |
$231.70
|
| Rate for Payer: One Health Plan PPO/POS |
$297.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$39.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$314.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$54.44
|
| Rate for Payer: Three Rivers Provider Network All |
$248.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.68
|
| Rate for Payer: United Healthcare Commercial |
$281.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$307.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$27.22
|
| Rate for Payer: Zelis Auto |
$132.40
|
| Rate for Payer: Zelis Medicare |
$23.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.66
|
| Rate for Payer: Zelis Worker's Compensation |
$28.80
|
|
|
PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/W
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
6145300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/W
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
6145300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$462.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$471.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$544.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$471.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$471.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/W
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
20399228
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/W
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
20399228
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$462.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$471.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$544.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$471.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$471.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
6145307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
6145307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,827.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,865.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,153.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,865.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,865.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
21600494
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,827.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cigna Commercial |
$452.20
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: First Health Workers Compensation |
$205.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$478.80
|
| Rate for Payer: GEHA Commercial |
$425.60
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$478.80
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,865.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$484.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$372.40
|
| Rate for Payer: One Health Plan PPO/POS |
$478.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,153.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,865.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$505.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$399.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,865.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$494.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$212.80
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$145.24
|
|
|
PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
21600494
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cigna Commercial |
$452.20
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: First Health Workers Compensation |
$205.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$478.80
|
| Rate for Payer: GEHA Commercial |
$372.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$478.80
|
| Rate for Payer: Multiplan All |
$484.12
|
| Rate for Payer: OMNI Networks Commercial |
$372.40
|
| Rate for Payer: One Health Plan PPO/POS |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$505.40
|
| Rate for Payer: Three Rivers Provider Network All |
$399.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$494.76
|
| Rate for Payer: Zelis Auto |
$212.80
|
| Rate for Payer: Zelis Worker's Compensation |
$145.24
|
|
|
PROCTOSIGMOIDOSCOPY ABLATE
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 45320
|
| Hospital Charge Code |
6145320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$134.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$243.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Worker's Compensation |
$95.00
|
|
|
PROCTOSIGMOIDOSCOPY ABLATE
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 45320
|
| Hospital Charge Code |
6145320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,307.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,827.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$134.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$278.40
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,865.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,153.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,865.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,865.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$95.00
|
|
|
PROCTOSIGMOIDOSCOPY BLEED
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 45317
|
| Hospital Charge Code |
6145317
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.19 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: First Health Workers Compensation |
$141.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$256.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: Zelis Auto |
$146.80
|
| Rate for Payer: Zelis Worker's Compensation |
$100.19
|
|
|
PROCTOSIGMOIDOSCOPY BLEED
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 45317
|
| Hospital Charge Code |
6145317
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.19 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$311.95
|
| Rate for Payer: First Health Commercial |
$330.30
|
| Rate for Payer: First Health Workers Compensation |
$141.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$330.30
|
| Rate for Payer: GEHA Commercial |
$293.60
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$330.30
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$333.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$256.90
|
| Rate for Payer: One Health Plan PPO/POS |
$330.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$348.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$275.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$341.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$146.80
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$100.19
|
|
|
PROCTOSIGMOIDOSCOPY DILATE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
6145303
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$216.00
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$73.71
|
|
|
PROCTOSIGMOIDOSCOPY DILATE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
6145303
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$229.50
|
| Rate for Payer: First Health Commercial |
$243.00
|
| Rate for Payer: First Health Workers Compensation |
$104.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$243.00
|
| Rate for Payer: GEHA Commercial |
$189.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$243.00
|
| Rate for Payer: Multiplan All |
$245.70
|
| Rate for Payer: OMNI Networks Commercial |
$189.00
|
| Rate for Payer: One Health Plan PPO/POS |
$243.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$256.50
|
| Rate for Payer: Three Rivers Provider Network All |
$202.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$251.10
|
| Rate for Payer: Zelis Auto |
$108.00
|
| Rate for Payer: Zelis Worker's Compensation |
$73.71
|
|
|
PROCTOSIGMOIDOSCOPY REMOVAL
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 45308
|
| Hospital Charge Code |
6145308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
PROCTOSIGMOIDOSCOPY REMOVAL
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 45315
|
| Hospital Charge Code |
6145315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| 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 |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| 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 |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$291.60
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$294.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| 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 |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$243.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$301.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$129.60
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$88.45
|
|
|
PROCTOSIGMOIDOSCOPY REMOVAL
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 45309
|
| Hospital Charge Code |
6145309
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.35 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$178.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$253.30
|
| Rate for Payer: First Health Commercial |
$268.20
|
| Rate for Payer: First Health Workers Compensation |
$115.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$268.20
|
| Rate for Payer: GEHA Commercial |
$238.40
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$268.20
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$271.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$208.60
|
| Rate for Payer: One Health Plan PPO/POS |
$268.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$283.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$223.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$277.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$119.20
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$81.35
|
|
|
PROCTOSIGMOIDOSCOPY REMOVAL
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 45315
|
| Hospital Charge Code |
6145315
|
|
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
|
|
|
PROCTOSIGMOIDOSCOPY REMOVAL
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 45308
|
| Hospital Charge Code |
6145308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
