|
respiratory pathogen prof pcr REF139650
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
2200625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Humana ChoiceCare |
$105.56
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$243.60
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$357.28
|
| Rate for Payer: United Healthcare Commercial |
$345.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$101.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$203.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
|
respiratory pathogen prof pcr REF139650
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
2200625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
|
RESTASIS 0.05% OPHTHALMIC GTTS
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
NDC 00023916330
|
| Hospital Charge Code |
3301829
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$57.80
|
| Rate for Payer: First Health Commercial |
$61.20
|
| Rate for Payer: First Health Workers Compensation |
$26.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$61.20
|
| Rate for Payer: GEHA Commercial |
$54.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$61.20
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Multiplan All |
$61.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.80
|
| Rate for Payer: OMNI Networks Commercial |
$47.60
|
| Rate for Payer: One Health Plan PPO/POS |
$61.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$64.60
|
| Rate for Payer: Three Rivers Provider Network All |
$51.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$59.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$63.24
|
| Rate for Payer: Zelis Auto |
$27.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.00
|
| Rate for Payer: Zelis Worker's Compensation |
$18.56
|
|
|
RESTASIS 0.05% OPHTHALMIC GTTS
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
NDC 00023916330
|
| Hospital Charge Code |
3301829
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$57.80
|
| Rate for Payer: First Health Commercial |
$61.20
|
| Rate for Payer: First Health Workers Compensation |
$26.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$61.20
|
| Rate for Payer: GEHA Commercial |
$47.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$61.20
|
| Rate for Payer: Multiplan All |
$61.88
|
| Rate for Payer: OMNI Networks Commercial |
$47.60
|
| Rate for Payer: One Health Plan PPO/POS |
$61.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$64.60
|
| Rate for Payer: Three Rivers Provider Network All |
$51.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$63.24
|
| Rate for Payer: Zelis Auto |
$27.20
|
| Rate for Payer: Zelis Worker's Compensation |
$18.56
|
|
|
REST/INDIRECT (SEPARATE PROCEDURE)
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
4094690
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
REST/INDIRECT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
4094690
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
RETACRIT 10000U/ML
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3303264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$363.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: First Health Workers Compensation |
$233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$8.63
|
| Rate for Payer: GEHA Medicare |
$7.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$8.63
|
| Rate for Payer: Humana Medicare Advantage |
$7.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.85
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.35
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.70
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.85
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Medicare |
$6.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.42
|
| Rate for Payer: Zelis Worker's Compensation |
$165.16
|
|
|
RETACRIT 10000U/ML
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3303264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$514.25
|
| Rate for Payer: First Health Commercial |
$544.50
|
| Rate for Payer: First Health Workers Compensation |
$233.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$544.50
|
| Rate for Payer: GEHA Commercial |
$423.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: OMNI Networks Commercial |
$423.50
|
| Rate for Payer: One Health Plan PPO/POS |
$544.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Worker's Compensation |
$165.16
|
|
|
RETACRIT 20000U/ML
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3303265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$928.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$586.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.85
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$8.63
|
| Rate for Payer: GEHA Medicare |
$7.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Humana ChoiceCare |
$8.63
|
| Rate for Payer: Humana Medicare Advantage |
$7.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.85
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.35
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.70
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.85
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Medicare |
$6.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.42
|
| Rate for Payer: Zelis Worker's Compensation |
$266.72
|
|
|
RETACRIT 20000U/ML
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
CPT Q5106
|
| Hospital Charge Code |
3303265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.72 |
| Max. Negotiated Rate |
$928.15 |
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$683.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Worker's Compensation |
$266.72
|
|
|
reticulocyte count REF005280
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
2205044
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.99
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$6.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$3.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$4.39
|
| Rate for Payer: Humana Medicare Advantage |
$3.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.99
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.78
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.98
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.91
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.99
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$3.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.79
|
| Rate for Payer: Zelis Worker's Compensation |
$4.61
|
|
|
reticulocyte count REF005280
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
2205044
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$6.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.61
|
|
|
reverse T3 REF070104
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
2299102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$383.35
|
| Rate for Payer: First Health Commercial |
$405.90
|
| Rate for Payer: First Health Workers Compensation |
$30.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.90
|
| Rate for Payer: GEHA Commercial |
$315.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.90
|
| Rate for Payer: Multiplan All |
$410.41
|
| Rate for Payer: OMNI Networks Commercial |
$315.70
|
| Rate for Payer: One Health Plan PPO/POS |
$405.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$428.45
|
| Rate for Payer: Three Rivers Provider Network All |
$338.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$419.43
|
| Rate for Payer: Zelis Auto |
$180.40
|
| Rate for Payer: Zelis Worker's Compensation |
$21.30
|
|
|
reverse T3 REF070104
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
2299102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$270.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.76
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$383.35
|
| Rate for Payer: First Health Commercial |
$405.90
|
| Rate for Payer: First Health Workers Compensation |
$30.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.90
|
| Rate for Payer: GEHA Commercial |
$360.80
|
| Rate for Payer: GEHA Medicare |
$15.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.90
|
| Rate for Payer: Humana ChoiceCare |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$15.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.76
|
| Rate for Payer: Multiplan All |
$410.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.79
|
| Rate for Payer: OMNI Networks Commercial |
$315.70
|
| Rate for Payer: One Health Plan PPO/POS |
$405.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$428.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$31.52
|
| Rate for Payer: Three Rivers Provider Network All |
$338.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.44
|
| Rate for Payer: United Healthcare Commercial |
$383.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$419.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.76
|
| Rate for Payer: Zelis Auto |
$180.40
|
| Rate for Payer: Zelis Medicare |
$13.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.91
|
| Rate for Payer: Zelis Worker's Compensation |
$21.30
|
|
|
REVIEW/REPORT BP RECORDING
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 93790
|
| Hospital Charge Code |
9000018
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$46.28
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$106.80
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$156.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$44.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$89.00
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
REVIEW/REPORT BP RECORDING
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 93790
|
| Hospital Charge Code |
9000018
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$68.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Worker's Compensation |
$48.59
|
|
|
REVISE ABDOMEN-VENOUS SHUNT
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 49426
|
| Hospital Charge Code |
6149426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.81 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$771.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,177.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,092.25
|
| Rate for Payer: First Health Commercial |
$1,156.50
|
| Rate for Payer: First Health Workers Compensation |
$496.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,156.50
|
| Rate for Payer: GEHA Commercial |
$1,028.00
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,156.50
|
| 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 |
$2,221.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$1,169.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$899.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,156.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,565.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,221.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,220.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$963.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,221.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,195.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$514.00
|
| 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 |
$350.81
|
|
|
REVISE ABDOMEN-VENOUS SHUNT
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 49426
|
| Hospital Charge Code |
6149426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.81 |
| Max. Negotiated Rate |
$1,220.75 |
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,092.25
|
| Rate for Payer: First Health Commercial |
$1,156.50
|
| Rate for Payer: First Health Workers Compensation |
$496.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,156.50
|
| Rate for Payer: GEHA Commercial |
$899.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,156.50
|
| Rate for Payer: Multiplan All |
$1,169.35
|
| Rate for Payer: OMNI Networks Commercial |
$899.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,156.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,220.75
|
| Rate for Payer: Three Rivers Provider Network All |
$963.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,195.05
|
| Rate for Payer: Zelis Auto |
$514.00
|
| Rate for Payer: Zelis Worker's Compensation |
$350.81
|
|
|
REVISE ADDITIONAL LEG TENDON
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 27692
|
| Hospital Charge Code |
6127692
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$4,709.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Humana ChoiceCare |
$85.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$197.40
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$164.50
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
REVISE ADDITIONAL LEG TENDON
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 27692
|
| Hospital Charge Code |
6127692
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT 64708
|
| Hospital Charge Code |
6164708
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$961.40 |
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$708.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 64708
|
| Hospital Charge Code |
6164708
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$809.60
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
REVISE BLADDER & URETER(S)
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT 51565
|
| Hospital Charge Code |
6151565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$734.10 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$1,038.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$1,882.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| Rate for Payer: Multiplan All |
$2,446.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,554.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,500.77
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Worker's Compensation |
$734.10
|
|
|
REVISE BLADDER & URETER(S)
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT 51565
|
| Hospital Charge Code |
6151565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$672.25 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,613.40
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$1,038.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$2,151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| Rate for Payer: Humana ChoiceCare |
$699.14
|
| Rate for Payer: Multiplan All |
$2,446.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,613.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,554.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,366.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$672.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,500.77
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,344.50
|
| Rate for Payer: Zelis Worker's Compensation |
$734.10
|
|
|
REVISE ESOPHAGUS & STOMACH
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
CPT 43325
|
| Hospital Charge Code |
6143325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$706.25 |
| Max. Negotiated Rate |
$2,683.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,695.00
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,401.25
|
| Rate for Payer: First Health Commercial |
$2,542.50
|
| Rate for Payer: First Health Workers Compensation |
$1,090.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,542.50
|
| Rate for Payer: GEHA Commercial |
$2,260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,542.50
|
| Rate for Payer: Humana ChoiceCare |
$734.50
|
| Rate for Payer: Multiplan All |
$2,570.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,695.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,977.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,542.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,683.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,118.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,486.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$706.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,627.25
|
| Rate for Payer: Zelis Auto |
$1,130.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,412.50
|
| Rate for Payer: Zelis Worker's Compensation |
$771.23
|
|
