|
BILE DUCT ENDOSCOPY ADD-ON
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 47550
|
| Hospital Charge Code |
6147550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$449.65
|
| Rate for Payer: First Health Commercial |
$476.10
|
| Rate for Payer: First Health Workers Compensation |
$204.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$476.10
|
| Rate for Payer: GEHA Commercial |
$423.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$476.10
|
| Rate for Payer: Humana ChoiceCare |
$137.54
|
| Rate for Payer: Multiplan All |
$481.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$317.40
|
| Rate for Payer: OMNI Networks Commercial |
$370.30
|
| Rate for Payer: One Health Plan PPO/POS |
$476.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$502.55
|
| Rate for Payer: Three Rivers Provider Network All |
$396.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$465.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$132.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.97
|
| Rate for Payer: Zelis Auto |
$211.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.50
|
| Rate for Payer: Zelis Worker's Compensation |
$144.42
|
|
|
BILE DUCT REVISION
|
Facility
|
OP
|
$3,559.00
|
|
|
Service Code
|
CPT 47701
|
| Hospital Charge Code |
6147701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$889.75 |
| Max. Negotiated Rate |
$3,381.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,135.40
|
| Rate for Payer: Cash Price |
$2,135.40
|
| Rate for Payer: Cigna Commercial |
$3,025.15
|
| Rate for Payer: First Health Commercial |
$3,203.10
|
| Rate for Payer: First Health Workers Compensation |
$1,374.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,203.10
|
| Rate for Payer: GEHA Commercial |
$2,847.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,203.10
|
| Rate for Payer: Humana ChoiceCare |
$925.34
|
| Rate for Payer: Multiplan All |
$3,238.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,135.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,491.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,203.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,381.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,669.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,131.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$889.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,309.87
|
| Rate for Payer: Zelis Auto |
$1,423.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,779.50
|
| Rate for Payer: Zelis Worker's Compensation |
$971.61
|
|
|
BILE DUCT REVISION
|
Facility
|
IP
|
$3,559.00
|
|
|
Service Code
|
CPT 47701
|
| Hospital Charge Code |
6147701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$971.61 |
| Max. Negotiated Rate |
$3,381.05 |
| Rate for Payer: Cash Price |
$2,135.40
|
| Rate for Payer: Cigna Commercial |
$3,025.15
|
| Rate for Payer: First Health Commercial |
$3,203.10
|
| Rate for Payer: First Health Workers Compensation |
$1,374.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,203.10
|
| Rate for Payer: GEHA Commercial |
$2,491.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,203.10
|
| Rate for Payer: Multiplan All |
$3,238.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,491.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,203.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,381.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,669.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,309.87
|
| Rate for Payer: Zelis Auto |
$1,423.60
|
| Rate for Payer: Zelis Worker's Compensation |
$971.61
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
6147554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$702.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
6147556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,462.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,512.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,901.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,512.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,512.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
6147555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$371.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$673.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| Rate for Payer: Multiplan All |
$875.42
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$913.90
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$894.66
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Worker's Compensation |
$262.63
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
6147555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$577.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,462.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$817.70
|
| Rate for Payer: First Health Commercial |
$865.80
|
| Rate for Payer: First Health Workers Compensation |
$371.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$865.80
|
| Rate for Payer: GEHA Commercial |
$769.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$865.80
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,512.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$875.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$673.40
|
| Rate for Payer: One Health Plan PPO/POS |
$865.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,901.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,512.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$913.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$721.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,512.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$894.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$384.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$262.63
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 47552
|
| Hospital Charge Code |
6147552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$11,849.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$487.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,462.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,924.89
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$313.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Humana ChoiceCare |
$6,517.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,924.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,953.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,512.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,924.89
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,901.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,512.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,512.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,924.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Medicare |
$5,036.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,109.87
|
| Rate for Payer: Zelis Worker's Compensation |
$221.68
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 47552
|
| Hospital Charge Code |
6147552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$771.40 |
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$313.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$568.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Worker's Compensation |
$221.68
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
6147553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$219.49 |
| Max. Negotiated Rate |
$763.80 |
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$683.40
|
| Rate for Payer: First Health Commercial |
$723.60
|
| Rate for Payer: First Health Workers Compensation |
$310.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$723.60
|
| Rate for Payer: GEHA Commercial |
$562.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$723.60
|
| Rate for Payer: Multiplan All |
$731.64
|
| Rate for Payer: OMNI Networks Commercial |
$562.80
|
| Rate for Payer: One Health Plan PPO/POS |
$723.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$763.80
|
| Rate for Payer: Three Rivers Provider Network All |
$603.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$747.72
|
| Rate for Payer: Zelis Auto |
$321.60
|
| Rate for Payer: Zelis Worker's Compensation |
$219.49
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
6147556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$613.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
6147553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$219.49 |
| Max. Negotiated Rate |
$11,849.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$482.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,462.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,924.89
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$683.40
|
| Rate for Payer: First Health Commercial |
$723.60
|
| Rate for Payer: First Health Workers Compensation |
$310.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$723.60
|
| Rate for Payer: GEHA Commercial |
$643.20
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$723.60
|
| Rate for Payer: Humana ChoiceCare |
$6,517.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,924.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,953.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,512.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,924.89
|
| Rate for Payer: Multiplan All |
$731.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| Rate for Payer: OMNI Networks Commercial |
$562.80
|
| Rate for Payer: One Health Plan PPO/POS |
$723.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,901.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,512.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$763.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: Three Rivers Provider Network All |
$603.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,806.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,512.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,924.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$747.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Auto |
$321.60
|
| Rate for Payer: Zelis Medicare |
$5,036.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,109.87
|
| Rate for Payer: Zelis Worker's Compensation |
$219.49
|
|
|
BILIARY ENDOSCOPY THRU SKIN
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
6147554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$601.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,108.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,462.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$802.40
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,512.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,901.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,512.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,512.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
BILIRUBIN, DIRECT/CONJUGATED (Vitros)
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
2232265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$8.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: GEHA Medicare |
$5.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$5.52
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.02
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.53
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.04
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.92
|
| Rate for Payer: United Healthcare Commercial |
$102.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.02
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Medicare |
$4.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.02
|
| Rate for Payer: Zelis Worker's Compensation |
$6.10
|
|
|
BILIRUBIN, DIRECT/CONJUGATED (Vitros)
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
2232265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$8.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6.10
|
|
|
BILIRUBIN, INDIRECT/UNCONJ.(Vitros)
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
2232266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$8.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6.10
|
|
|
BILIRUBIN, INDIRECT/UNCONJ.(Vitros)
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
2232266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$8.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: GEHA Medicare |
$5.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$5.52
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.02
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.53
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.04
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.92
|
| Rate for Payer: United Healthcare Commercial |
$102.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.02
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Medicare |
$4.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.02
|
| Rate for Payer: Zelis Worker's Compensation |
$6.10
|
|
|
BILIRUBIN TOTAL (Non Pediatric) (Vitros)
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
2232203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$8.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$5.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$5.52
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.02
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.53
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.04
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.92
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.02
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$4.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.02
|
| Rate for Payer: Zelis Worker's Compensation |
$6.10
|
|
|
BILIRUBIN TOTAL (Non Pediatric) (Vitros)
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
2232203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$8.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.10
|
|
|
BILOBECTOMY
|
Facility
|
OP
|
$3,340.00
|
|
|
Service Code
|
CPT 32482
|
| Hospital Charge Code |
6132482
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$835.00 |
| Max. Negotiated Rate |
$3,173.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$2,839.00
|
| Rate for Payer: First Health Commercial |
$3,006.00
|
| Rate for Payer: First Health Workers Compensation |
$1,289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,006.00
|
| Rate for Payer: GEHA Commercial |
$2,672.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,006.00
|
| Rate for Payer: Humana ChoiceCare |
$868.40
|
| Rate for Payer: Multiplan All |
$3,039.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,004.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,338.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,006.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,173.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,505.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,939.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$835.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,106.20
|
| Rate for Payer: Zelis Auto |
$1,336.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,670.00
|
| Rate for Payer: Zelis Worker's Compensation |
$911.82
|
|
|
BILOBECTOMY
|
Facility
|
IP
|
$3,340.00
|
|
|
Service Code
|
CPT 32482
|
| Hospital Charge Code |
6132482
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$911.82 |
| Max. Negotiated Rate |
$3,173.00 |
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$2,839.00
|
| Rate for Payer: First Health Commercial |
$3,006.00
|
| Rate for Payer: First Health Workers Compensation |
$1,289.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,006.00
|
| Rate for Payer: GEHA Commercial |
$2,338.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,006.00
|
| Rate for Payer: Multiplan All |
$3,039.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,338.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,006.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,173.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,505.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,106.20
|
| Rate for Payer: Zelis Auto |
$1,336.00
|
| Rate for Payer: Zelis Worker's Compensation |
$911.82
|
|
|
BIMATOPROST OPHTH SOLN 0.01%
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
NDC 00023320503
|
| Hospital Charge Code |
3300105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: First Health Workers Compensation |
$177.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$367.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Humana ChoiceCare |
$119.34
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$275.40
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$403.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.50
|
| Rate for Payer: Zelis Worker's Compensation |
$125.31
|
|
|
BIMATOPROST OPHTH SOLN 0.01%
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
NDC 00023320503
|
| Hospital Charge Code |
3300105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$390.15
|
| Rate for Payer: First Health Commercial |
$413.10
|
| Rate for Payer: First Health Workers Compensation |
$177.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$413.10
|
| Rate for Payer: GEHA Commercial |
$321.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$413.10
|
| Rate for Payer: Multiplan All |
$417.69
|
| Rate for Payer: OMNI Networks Commercial |
$321.30
|
| Rate for Payer: One Health Plan PPO/POS |
$413.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$436.05
|
| Rate for Payer: Three Rivers Provider Network All |
$344.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$426.87
|
| Rate for Payer: Zelis Auto |
$183.60
|
| Rate for Payer: Zelis Worker's Compensation |
$125.31
|
|
|
BIOFDBK TRNG PERINL MUSC ANORECT/URO SPH
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
8499250
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$182.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
BIOFDBK TRNG PERINL MUSC ANORECT/URO SPH
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
9599253
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$182.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
