|
BRIMONIDINE 0.1% OPHTHALMIC
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
3301828
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: First Health Commercial |
$662.40
|
| Rate for Payer: First Health Workers Compensation |
$284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$662.40
|
| Rate for Payer: GEHA Commercial |
$515.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$662.40
|
| Rate for Payer: Multiplan All |
$669.76
|
| Rate for Payer: OMNI Networks Commercial |
$515.20
|
| Rate for Payer: One Health Plan PPO/POS |
$662.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$699.20
|
| Rate for Payer: Three Rivers Provider Network All |
$552.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$684.48
|
| Rate for Payer: Zelis Auto |
$294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$200.93
|
|
|
BRIMONIDINE TARTRATE OPTH SOLN 0.2%
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
NDC 24208041110
|
| Hospital Charge Code |
3300112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$89.25
|
| Rate for Payer: First Health Commercial |
$94.50
|
| Rate for Payer: First Health Workers Compensation |
$40.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.50
|
| Rate for Payer: GEHA Commercial |
$73.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.50
|
| Rate for Payer: Multiplan All |
$95.55
|
| Rate for Payer: OMNI Networks Commercial |
$73.50
|
| Rate for Payer: One Health Plan PPO/POS |
$94.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.75
|
| Rate for Payer: Three Rivers Provider Network All |
$78.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.65
|
| Rate for Payer: Zelis Auto |
$42.00
|
| Rate for Payer: Zelis Worker's Compensation |
$28.66
|
|
|
BRIMONIDINE TARTRATE OPTH SOLN 0.2%
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
NDC 24208041110
|
| Hospital Charge Code |
3300112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$89.25
|
| Rate for Payer: First Health Commercial |
$94.50
|
| Rate for Payer: First Health Workers Compensation |
$40.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$94.50
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$94.50
|
| Rate for Payer: Humana ChoiceCare |
$27.30
|
| Rate for Payer: Multiplan All |
$95.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.00
|
| Rate for Payer: OMNI Networks Commercial |
$73.50
|
| Rate for Payer: One Health Plan PPO/POS |
$94.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$99.75
|
| Rate for Payer: Three Rivers Provider Network All |
$78.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$92.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$97.65
|
| Rate for Payer: Zelis Auto |
$42.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.50
|
| Rate for Payer: Zelis Worker's Compensation |
$28.66
|
|
|
BRIUMVI 150MG/6 ML PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J2329
|
| Hospital Charge Code |
3303254
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
BRIUMVI 150MG/6 ML PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J2329
|
| Hospital Charge Code |
3303254
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$141.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$82.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$70.75
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$77.83
|
| Rate for Payer: GEHA Medicare |
$70.75
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$77.83
|
| Rate for Payer: Humana Medicare Advantage |
$70.75
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$118.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$83.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$70.75
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$120.28
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$96.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$83.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$70.75
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$141.50
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$69.33
|
| Rate for Payer: United Healthcare Managed Medicaid |
$83.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$70.75
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$60.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$84.90
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
BRONCHOSCOPY, CLEAR AIRWAYS
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
6131645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.77 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$350.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
|
BRONCHOSCOPY, CLEAR AIRWAYS
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
6131645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.77 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna Commercial |
$425.85
|
| Rate for Payer: First Health Commercial |
$450.90
|
| Rate for Payer: First Health Workers Compensation |
$193.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.90
|
| Rate for Payer: GEHA Commercial |
$400.80
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.90
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$455.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$350.70
|
| Rate for Payer: One Health Plan PPO/POS |
$450.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$375.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$200.40
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$136.77
|
|
|
BRONCHOSCOPY/LUNG BX, EACH
|
Facility
|
IP
|
$586.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
6131628
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$498.10
|
| Rate for Payer: First Health Commercial |
$527.40
|
| Rate for Payer: First Health Workers Compensation |
$226.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$527.40
|
| Rate for Payer: GEHA Commercial |
$410.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$527.40
|
| Rate for Payer: Multiplan All |
$533.26
|
| Rate for Payer: OMNI Networks Commercial |
$410.20
|
| Rate for Payer: One Health Plan PPO/POS |
$527.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$556.70
|
| Rate for Payer: Three Rivers Provider Network All |
$439.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.98
|
| Rate for Payer: Zelis Auto |
$234.40
|
| Rate for Payer: Zelis Worker's Compensation |
$159.98
|
|
|
BRONCHOSCOPY/LUNG BX, EACH
|
Facility
|
OP
|
$586.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
6131628
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$351.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$498.10
|
| Rate for Payer: First Health Commercial |
$527.40
|
| Rate for Payer: First Health Workers Compensation |
$226.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$527.40
|
| Rate for Payer: GEHA Commercial |
$468.80
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$527.40
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$533.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$410.20
|
| Rate for Payer: One Health Plan PPO/POS |
$527.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$556.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$439.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$544.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$234.40
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$159.98
|
|
|
BRONCHOSCOPY/NEEDLE BX, EACH
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
6131629
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
BRONCHOSCOPY/NEEDLE BX, EACH
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
6131629
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$362.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
BRONCHOSCOPY, RECLEAR AIRWAY
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
6131646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$118.21 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$368.05
|
| Rate for Payer: First Health Commercial |
$389.70
|
| Rate for Payer: First Health Workers Compensation |
$167.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$389.70
|
| Rate for Payer: GEHA Commercial |
$303.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$389.70
|
| Rate for Payer: Multiplan All |
$394.03
|
| Rate for Payer: OMNI Networks Commercial |
$303.10
|
| Rate for Payer: One Health Plan PPO/POS |
$389.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$411.35
|
| Rate for Payer: Three Rivers Provider Network All |
$324.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$402.69
|
| Rate for Payer: Zelis Auto |
$173.20
|
| Rate for Payer: Zelis Worker's Compensation |
$118.21
|
|
|
BRONCHOSCOPY, RECLEAR AIRWAY
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 31646
|
| Hospital Charge Code |
6131646
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$118.21 |
| Max. Negotiated Rate |
$1,048.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$368.72
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$368.05
|
| Rate for Payer: First Health Commercial |
$389.70
|
| Rate for Payer: First Health Workers Compensation |
$167.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$389.70
|
| Rate for Payer: GEHA Commercial |
$346.40
|
| Rate for Payer: GEHA Medicare |
$368.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$389.70
|
| Rate for Payer: Humana ChoiceCare |
$405.59
|
| Rate for Payer: Humana Medicare Advantage |
$368.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$619.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$368.72
|
| Rate for Payer: Multiplan All |
$394.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$626.82
|
| Rate for Payer: OMNI Networks Commercial |
$303.10
|
| Rate for Payer: One Health Plan PPO/POS |
$389.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$368.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$411.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$737.44
|
| Rate for Payer: Three Rivers Provider Network All |
$324.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$361.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$368.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$402.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$368.72
|
| Rate for Payer: Zelis Auto |
$173.20
|
| Rate for Payer: Zelis Medicare |
$313.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$442.46
|
| Rate for Payer: Zelis Worker's Compensation |
$118.21
|
|
|
BRONCHOSCOPY W/BIOPSY(S)
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
6131625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
BRONCHOSCOPY W/BIOPSY(S)
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
6131625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
BRONCHOSCOPY W/MARKERS
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
6131626
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$376.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$501.60
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
BRONCHOSCOPY W/MARKERS
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
6131626
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$438.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
BRONCH THERMOPLSTY 1 LOBE
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
6131660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,229.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,229.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,765.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$210.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$435.20
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,801.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,080.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,801.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,801.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$148.51
|
|
|
BRONCH THERMOPLSTY 1 LOBE
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 31660
|
| Hospital Charge Code |
6131660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$210.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$380.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Worker's Compensation |
$148.51
|
|
|
BRONCH W/BALLOON OCCLUSION
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
6131634
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,061.70
|
| 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 |
$1,061.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$841.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| 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 |
$484.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$544.50
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$858.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$550.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| 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 |
$990.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$858.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$574.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$453.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$858.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$562.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$242.00
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$165.16
|
|
|
BRONCH W/BALLOON OCCLUSION
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
6131634
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
brucella ab, IgM REF164624
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
2200611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$14.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: GEHA Medicare |
$8.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$9.82
|
| Rate for Payer: Humana Medicare Advantage |
$8.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.93
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.18
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.86
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.75
|
| Rate for Payer: United Healthcare Commercial |
$95.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.93
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Medicare |
$7.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.72
|
| Rate for Payer: Zelis Worker's Compensation |
$10.14
|
|
|
brucella ab, IgM REF164624
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
2200611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: First Health Workers Compensation |
$14.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.14
|
|
|
BSO, OMENTECTOMY W/TAH
|
Facility
|
IP
|
$2,859.00
|
|
|
Service Code
|
CPT 58956
|
| Hospital Charge Code |
6158956
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$780.51 |
| Max. Negotiated Rate |
$2,716.05 |
| Rate for Payer: Cash Price |
$1,715.40
|
| Rate for Payer: Cigna Commercial |
$2,430.15
|
| Rate for Payer: First Health Commercial |
$2,573.10
|
| Rate for Payer: First Health Workers Compensation |
$1,103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,573.10
|
| Rate for Payer: GEHA Commercial |
$2,001.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,573.10
|
| Rate for Payer: Multiplan All |
$2,601.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,001.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,573.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,716.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,144.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,658.87
|
| Rate for Payer: Zelis Auto |
$1,143.60
|
| Rate for Payer: Zelis Worker's Compensation |
$780.51
|
|
|
BSO, OMENTECTOMY W/TAH
|
Facility
|
OP
|
$2,859.00
|
|
|
Service Code
|
CPT 58956
|
| Hospital Charge Code |
6158956
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$714.75 |
| Max. Negotiated Rate |
$2,716.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,715.40
|
| Rate for Payer: Cash Price |
$1,715.40
|
| Rate for Payer: Cigna Commercial |
$2,430.15
|
| Rate for Payer: First Health Commercial |
$2,573.10
|
| Rate for Payer: First Health Workers Compensation |
$1,103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,573.10
|
| Rate for Payer: GEHA Commercial |
$2,287.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,573.10
|
| Rate for Payer: Humana ChoiceCare |
$743.34
|
| Rate for Payer: Multiplan All |
$2,601.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,715.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,001.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,573.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,716.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,144.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,515.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,658.87
|
| Rate for Payer: Zelis Auto |
$1,143.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,429.50
|
| Rate for Payer: Zelis Worker's Compensation |
$780.51
|
|
