|
SLINGS
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
7204565
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
SLITTING OF PREPUCE
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
6154001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$115.75
|
|
|
SLITTING OF PREPUCE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 54000
|
| Hospital Charge Code |
6154000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: First Health Workers Compensation |
$127.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$264.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$132.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$90.09
|
|
|
SLITTING OF PREPUCE
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
6154001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$163.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$115.75
|
|
|
SLITTING OF PREPUCE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 54000
|
| Hospital Charge Code |
6154000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: First Health Workers Compensation |
$127.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$231.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: Zelis Auto |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.09
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
6144378
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.95 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$494.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$700.40
|
| Rate for Payer: First Health Commercial |
$741.60
|
| Rate for Payer: First Health Workers Compensation |
$318.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$741.60
|
| Rate for Payer: GEHA Commercial |
$659.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$741.60
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$749.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$576.80
|
| Rate for Payer: One Health Plan PPO/POS |
$741.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$782.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$618.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$766.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$329.60
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$224.95
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
6144380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$135.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
6144378
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.95 |
| Max. Negotiated Rate |
$782.80 |
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$700.40
|
| Rate for Payer: First Health Commercial |
$741.60
|
| Rate for Payer: First Health Workers Compensation |
$318.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$741.60
|
| Rate for Payer: GEHA Commercial |
$576.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$741.60
|
| Rate for Payer: Multiplan All |
$749.84
|
| Rate for Payer: OMNI Networks Commercial |
$576.80
|
| Rate for Payer: One Health Plan PPO/POS |
$741.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$782.80
|
| Rate for Payer: Three Rivers Provider Network All |
$618.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$766.32
|
| Rate for Payer: Zelis Auto |
$329.60
|
| Rate for Payer: Zelis Worker's Compensation |
$224.95
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
6144382
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.34 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$197.20
|
| Rate for Payer: First Health Commercial |
$208.80
|
| Rate for Payer: First Health Workers Compensation |
$89.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$208.80
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$208.80
|
| Rate for Payer: Multiplan All |
$211.12
|
| Rate for Payer: OMNI Networks Commercial |
$162.40
|
| Rate for Payer: One Health Plan PPO/POS |
$208.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$220.40
|
| Rate for Payer: Three Rivers Provider Network All |
$174.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$215.76
|
| Rate for Payer: Zelis Auto |
$92.80
|
| Rate for Payer: Zelis Worker's Compensation |
$63.34
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
6144373
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.51 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$469.80
|
| Rate for Payer: First Health Workers Compensation |
$201.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$469.80
|
| Rate for Payer: GEHA Commercial |
$417.60
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$469.80
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$475.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$365.40
|
| Rate for Payer: One Health Plan PPO/POS |
$469.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$495.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$391.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$485.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$208.80
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$142.51
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
6144364
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.70 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$213.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Worker's Compensation |
$150.70
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
6144363
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$415.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
6144380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 44366
|
| Hospital Charge Code |
6144366
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.90 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$583.20
|
| Rate for Payer: First Health Workers Compensation |
$250.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$583.20
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$583.20
|
| Rate for Payer: Multiplan All |
$589.68
|
| Rate for Payer: OMNI Networks Commercial |
$453.60
|
| Rate for Payer: One Health Plan PPO/POS |
$583.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$615.60
|
| Rate for Payer: Three Rivers Provider Network All |
$486.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$602.64
|
| Rate for Payer: Zelis Auto |
$259.20
|
| Rate for Payer: Zelis Worker's Compensation |
$176.90
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
6144365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.61 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: First Health Workers Compensation |
$224.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.90
|
| Rate for Payer: GEHA Commercial |
$406.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.90
|
| Rate for Payer: Multiplan All |
$528.71
|
| Rate for Payer: OMNI Networks Commercial |
$406.70
|
| Rate for Payer: One Health Plan PPO/POS |
$522.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.95
|
| Rate for Payer: Three Rivers Provider Network All |
$435.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$540.33
|
| Rate for Payer: Zelis Auto |
$232.40
|
| Rate for Payer: Zelis Worker's Compensation |
$158.61
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
6144372
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$551.65
|
| Rate for Payer: First Health Commercial |
$584.10
|
| Rate for Payer: First Health Workers Compensation |
$250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$584.10
|
| Rate for Payer: GEHA Commercial |
$519.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$584.10
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$590.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$454.30
|
| Rate for Payer: One Health Plan PPO/POS |
$584.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$616.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$486.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$603.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$259.60
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$177.18
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
CPT 44365
|
| Hospital Charge Code |
6144365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.61 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$522.90
|
| Rate for Payer: First Health Workers Compensation |
$224.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.90
|
| Rate for Payer: GEHA Commercial |
$464.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.90
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$528.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$406.70
|
| Rate for Payer: One Health Plan PPO/POS |
$522.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$435.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$540.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$232.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$158.61
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
6144373
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.51 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$469.80
|
| Rate for Payer: First Health Workers Compensation |
$201.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$469.80
|
| Rate for Payer: GEHA Commercial |
$365.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$469.80
|
| Rate for Payer: Multiplan All |
$475.02
|
| Rate for Payer: OMNI Networks Commercial |
$365.40
|
| Rate for Payer: One Health Plan PPO/POS |
$469.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$495.90
|
| Rate for Payer: Three Rivers Provider Network All |
$391.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$485.46
|
| Rate for Payer: Zelis Auto |
$208.80
|
| Rate for Payer: Zelis Worker's Compensation |
$142.51
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 44369
|
| Hospital Charge Code |
6144369
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$563.55
|
| Rate for Payer: First Health Commercial |
$596.70
|
| Rate for Payer: First Health Workers Compensation |
$255.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$596.70
|
| Rate for Payer: GEHA Commercial |
$530.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$596.70
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$603.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$464.10
|
| Rate for Payer: One Health Plan PPO/POS |
$596.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$629.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$497.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$616.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$265.20
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$181.00
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 44366
|
| Hospital Charge Code |
6144366
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.90 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$388.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$583.20
|
| Rate for Payer: First Health Workers Compensation |
$250.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$583.20
|
| Rate for Payer: GEHA Commercial |
$518.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$583.20
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$589.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$453.60
|
| Rate for Payer: One Health Plan PPO/POS |
$583.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$615.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$486.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$602.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$259.20
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$176.90
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 44376
|
| Hospital Charge Code |
6144376
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.57 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$458.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna Commercial |
$649.40
|
| Rate for Payer: First Health Commercial |
$687.60
|
| Rate for Payer: First Health Workers Compensation |
$294.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$687.60
|
| Rate for Payer: GEHA Commercial |
$611.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$687.60
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$695.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$534.80
|
| Rate for Payer: One Health Plan PPO/POS |
$687.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$725.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$573.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$710.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$305.60
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$208.57
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 44372
|
| Hospital Charge Code |
6144372
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$551.65
|
| Rate for Payer: First Health Commercial |
$584.10
|
| Rate for Payer: First Health Workers Compensation |
$250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$584.10
|
| Rate for Payer: GEHA Commercial |
$454.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$584.10
|
| Rate for Payer: Multiplan All |
$590.59
|
| Rate for Payer: OMNI Networks Commercial |
$454.30
|
| Rate for Payer: One Health Plan PPO/POS |
$584.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$616.55
|
| Rate for Payer: Three Rivers Provider Network All |
$486.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$603.57
|
| Rate for Payer: Zelis Auto |
$259.60
|
| Rate for Payer: Zelis Worker's Compensation |
$177.18
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 44360
|
| Hospital Charge Code |
6144360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$181.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$329.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| Rate for Payer: Multiplan All |
$427.70
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$446.50
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$437.10
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Worker's Compensation |
$128.31
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 44376
|
| Hospital Charge Code |
6144376
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.57 |
| Max. Negotiated Rate |
$725.80 |
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna Commercial |
$649.40
|
| Rate for Payer: First Health Commercial |
$687.60
|
| Rate for Payer: First Health Workers Compensation |
$294.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$687.60
|
| Rate for Payer: GEHA Commercial |
$534.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$687.60
|
| Rate for Payer: Multiplan All |
$695.24
|
| Rate for Payer: OMNI Networks Commercial |
$534.80
|
| Rate for Payer: One Health Plan PPO/POS |
$687.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$725.80
|
| Rate for Payer: Three Rivers Provider Network All |
$573.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$710.52
|
| Rate for Payer: Zelis Auto |
$305.60
|
| Rate for Payer: Zelis Worker's Compensation |
$208.57
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
6144364
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.70 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$213.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$150.70
|
|
