|
PROCTOSIGMOIDOSCOPY REMOVAL
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 45309
|
| Hospital Charge Code |
6145309
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.35 |
| Max. Negotiated Rate |
$283.10 |
| 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 |
$208.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$268.20
|
| Rate for Payer: Multiplan All |
$271.18
|
| Rate for Payer: OMNI Networks Commercial |
$208.60
|
| Rate for Payer: One Health Plan PPO/POS |
$268.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$283.10
|
| Rate for Payer: Three Rivers Provider Network All |
$223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$277.14
|
| Rate for Payer: Zelis Auto |
$119.20
|
| Rate for Payer: Zelis Worker's Compensation |
$81.35
|
|
|
PROCTOSIGMOIDOSCOPY VOLVUL
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
6145321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$5,314.64 |
| 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 |
$202.20
|
| 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 |
$2,657.32
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: First Health Workers Compensation |
$130.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$269.60
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,865.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| 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 |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,865.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$134.80
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$92.00
|
|
|
PROCTOSIGMOIDOSCOPY VOLVUL
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
6145321
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: First Health Workers Compensation |
$130.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$235.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: Zelis Auto |
$134.80
|
| Rate for Payer: Zelis Worker's Compensation |
$92.00
|
|
|
PROCTOSIGMOIDOSCOPY W/BX
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
6145305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: First Health Commercial |
$221.40
|
| Rate for Payer: First Health Workers Compensation |
$94.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$221.40
|
| Rate for Payer: GEHA Commercial |
$172.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$221.40
|
| Rate for Payer: Multiplan All |
$223.86
|
| Rate for Payer: OMNI Networks Commercial |
$172.20
|
| Rate for Payer: One Health Plan PPO/POS |
$221.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$233.70
|
| Rate for Payer: Three Rivers Provider Network All |
$184.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$228.78
|
| Rate for Payer: Zelis Auto |
$98.40
|
| Rate for Payer: Zelis Worker's Compensation |
$67.16
|
|
|
PROCTOSIGMOIDOSCOPY W/BX
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
6145305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$2,285.00 |
| 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 |
$147.60
|
| 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 |
$1,142.50
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: First Health Commercial |
$221.40
|
| Rate for Payer: First Health Workers Compensation |
$94.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$221.40
|
| Rate for Payer: GEHA Commercial |
$196.80
|
| Rate for Payer: GEHA Medicare |
$1,142.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$221.40
|
| Rate for Payer: Humana ChoiceCare |
$1,256.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,142.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,919.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,142.50
|
| Rate for Payer: Multiplan All |
$223.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,942.25
|
| Rate for Payer: OMNI Networks Commercial |
$172.20
|
| Rate for Payer: One Health Plan PPO/POS |
$221.40
|
| 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 |
$1,142.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$233.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,285.00
|
| Rate for Payer: Three Rivers Provider Network All |
$184.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,119.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,142.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$228.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,142.50
|
| Rate for Payer: Zelis Auto |
$98.40
|
| Rate for Payer: Zelis Medicare |
$971.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,371.00
|
| Rate for Payer: Zelis Worker's Compensation |
$67.16
|
|
|
PROCTOSIGMOIDOSCOPY W/STENT
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 45327
|
| Hospital Charge Code |
6145327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$11,536.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,678.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,678.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,121.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,768.15
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$308.00
|
| Rate for Payer: GEHA Medicare |
$5,768.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Humana ChoiceCare |
$6,344.97
|
| Rate for Payer: Humana Medicare Advantage |
$5,768.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,690.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,165.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,768.15
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,805.85
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,499.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,165.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,768.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,536.30
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,652.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,165.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,768.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,768.15
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Medicare |
$4,902.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,921.78
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
PROCTOSIGMOIDOSCOPY W/STENT
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 45327
|
| Hospital Charge Code |
6145327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
PROFEE CRTL CR EA ADD 30MIN
|
Facility
|
OP
|
$1,671.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
8199292
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$417.75 |
| Max. Negotiated Rate |
$1,587.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,002.60
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cigna Commercial |
$1,420.35
|
| Rate for Payer: First Health Commercial |
$1,503.90
|
| Rate for Payer: First Health Workers Compensation |
$645.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.90
|
| Rate for Payer: GEHA Commercial |
$1,336.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.90
|
| Rate for Payer: Humana ChoiceCare |
$434.46
|
| Rate for Payer: Multiplan All |
$1,520.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,002.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,587.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,253.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,470.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$417.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,554.03
|
| Rate for Payer: Zelis Auto |
$668.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$835.50
|
| Rate for Payer: Zelis Worker's Compensation |
$456.18
|
|
|
PROFEE CRTL CR EA ADD 30MIN
|
Facility
|
IP
|
$1,671.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
8199292
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$456.18 |
| Max. Negotiated Rate |
$1,587.45 |
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cigna Commercial |
$1,420.35
|
| Rate for Payer: First Health Commercial |
$1,503.90
|
| Rate for Payer: First Health Workers Compensation |
$645.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.90
|
| Rate for Payer: GEHA Commercial |
$1,169.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.90
|
| Rate for Payer: Multiplan All |
$1,520.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,587.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,253.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,554.03
|
| Rate for Payer: Zelis Auto |
$668.40
|
| Rate for Payer: Zelis Worker's Compensation |
$456.18
|
|
|
PROFEE DRAINING ABCESS DENTOALVEOLAR
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6111766
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
PROFEE DRAINING ABCESS DENTOALVEOLAR
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6111766
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$106.17 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$365.60
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$118.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$118.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$118.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
PROFEE ED SERVICE CRITICAL 30-74 MIN
|
Facility
|
OP
|
$688.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8199291
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$1,632.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$588.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$816.47
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$584.80
|
| Rate for Payer: First Health Commercial |
$619.20
|
| Rate for Payer: First Health Workers Compensation |
$265.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$619.20
|
| Rate for Payer: GEHA Commercial |
$550.40
|
| Rate for Payer: GEHA Medicare |
$816.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$619.20
|
| Rate for Payer: Humana ChoiceCare |
$898.12
|
| Rate for Payer: Humana Medicare Advantage |
$816.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,371.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$600.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$816.47
|
| Rate for Payer: Multiplan All |
$626.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,388.00
|
| Rate for Payer: OMNI Networks Commercial |
$481.60
|
| Rate for Payer: One Health Plan PPO/POS |
$619.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$693.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$600.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$816.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$653.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,632.94
|
| Rate for Payer: Three Rivers Provider Network All |
$516.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$800.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$600.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$816.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$639.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$816.47
|
| Rate for Payer: Zelis Auto |
$275.20
|
| Rate for Payer: Zelis Medicare |
$694.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$979.76
|
| Rate for Payer: Zelis Worker's Compensation |
$187.82
|
|
|
PROFEE ED SERVICE CRITICAL 30-74 MIN
|
Facility
|
IP
|
$688.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
8199291
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$653.60 |
| Rate for Payer: Zelis Auto |
$275.20
|
| Rate for Payer: Zelis Worker's Compensation |
$187.82
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$584.80
|
| Rate for Payer: First Health Commercial |
$619.20
|
| Rate for Payer: First Health Workers Compensation |
$265.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$619.20
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$619.20
|
| Rate for Payer: Multiplan All |
$626.08
|
| Rate for Payer: OMNI Networks Commercial |
$481.60
|
| Rate for Payer: One Health Plan PPO/POS |
$619.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$653.60
|
| Rate for Payer: Three Rivers Provider Network All |
$516.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$639.84
|
|
|
PROFEE ESOPH IMPED FUNCTION TEST
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
6191037
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
PROFEE ESOPH IMPED FUNCTION TEST
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
6191037
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$603.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$211.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$167.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$301.74
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$301.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Humana ChoiceCare |
$331.91
|
| Rate for Payer: Humana Medicare Advantage |
$301.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$506.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$301.74
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.96
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$197.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$301.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$603.48
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$295.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$301.74
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$256.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$362.09
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
PROFEE ONLY 70220 XR SINUSES 3+VWA
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
2407256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$170.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$85.32
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$75.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
PROFEE ONLY 70220 XR SINUSES 3+VWA
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
2407256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$45.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$32.12
|
|
|
PROFEE-TEST ITEM
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
8675306
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
PROFEE-TEST ITEM
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
8675306
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$8.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
|
|
PROGESTERONE 100 MG CAP
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
3303204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
PROGESTERONE 100 MG CAP
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
3303204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
progesterone REF004317
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
2234144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.86
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: First Health Commercial |
$221.40
|
| Rate for Payer: First Health Workers Compensation |
$36.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$221.40
|
| Rate for Payer: GEHA Commercial |
$196.80
|
| Rate for Payer: GEHA Medicare |
$20.86
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$221.40
|
| Rate for Payer: Humana ChoiceCare |
$22.95
|
| Rate for Payer: Humana Medicare Advantage |
$20.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.86
|
| Rate for Payer: Multiplan All |
$223.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.46
|
| Rate for Payer: OMNI Networks Commercial |
$172.20
|
| Rate for Payer: One Health Plan PPO/POS |
$221.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$233.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.72
|
| Rate for Payer: Three Rivers Provider Network All |
$184.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.44
|
| Rate for Payer: United Healthcare Commercial |
$209.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$228.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.86
|
| Rate for Payer: Zelis Auto |
$98.40
|
| Rate for Payer: Zelis Medicare |
$17.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.03
|
| Rate for Payer: Zelis Worker's Compensation |
$26.07
|
|
|
progesterone REF004317
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
2234144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna Commercial |
$209.10
|
| Rate for Payer: First Health Commercial |
$221.40
|
| Rate for Payer: First Health Workers Compensation |
$36.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$221.40
|
| Rate for Payer: GEHA Commercial |
$172.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$221.40
|
| Rate for Payer: Multiplan All |
$223.86
|
| Rate for Payer: OMNI Networks Commercial |
$172.20
|
| Rate for Payer: One Health Plan PPO/POS |
$221.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$233.70
|
| Rate for Payer: Three Rivers Provider Network All |
$184.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$228.78
|
| Rate for Payer: Zelis Auto |
$98.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.07
|
|
|
prograf (tacrolimus) REF700248
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
2239391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$24.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$215.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$24.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$19.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cigna Commercial |
$305.15
|
| Rate for Payer: First Health Commercial |
$323.10
|
| Rate for Payer: First Health Workers Compensation |
$24.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$323.10
|
| Rate for Payer: GEHA Commercial |
$287.20
|
| Rate for Payer: GEHA Medicare |
$13.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$323.10
|
| Rate for Payer: Humana ChoiceCare |
$15.10
|
| Rate for Payer: Humana Medicare Advantage |
$13.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$23.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$19.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$13.73
|
| Rate for Payer: Multiplan All |
$326.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.34
|
| Rate for Payer: OMNI Networks Commercial |
$251.30
|
| Rate for Payer: One Health Plan PPO/POS |
$323.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$23.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$13.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$341.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$27.46
|
| Rate for Payer: Three Rivers Provider Network All |
$269.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$305.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$333.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$13.73
|
| Rate for Payer: Zelis Auto |
$143.60
|
| Rate for Payer: Zelis Medicare |
$11.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.48
|
| Rate for Payer: Zelis Worker's Compensation |
$17.44
|
|
|
prograf (tacrolimus) REF700248
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
2239391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cigna Commercial |
$305.15
|
| Rate for Payer: First Health Commercial |
$323.10
|
| Rate for Payer: First Health Workers Compensation |
$24.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$323.10
|
| Rate for Payer: GEHA Commercial |
$251.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$323.10
|
| Rate for Payer: Multiplan All |
$326.69
|
| Rate for Payer: OMNI Networks Commercial |
$251.30
|
| Rate for Payer: One Health Plan PPO/POS |
$323.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$341.05
|
| Rate for Payer: Three Rivers Provider Network All |
$269.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$333.87
|
| Rate for Payer: Zelis Auto |
$143.60
|
| Rate for Payer: Zelis Worker's Compensation |
$17.44
|
|
