|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
7664999
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
6164999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$478.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$637.60
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
20364999
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
6164999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$217.58 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: First Health Workers Compensation |
$307.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$557.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
| Rate for Payer: Zelis Worker's Compensation |
$217.58
|
|
|
UNLISTED PROCEDURE, NERVOUS SYSTEM
|
Facility
|
OP
|
$572.06
|
|
|
Service Code
|
CPT 64999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$260.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$286.03
|
| Rate for Payer: First Health Workers Compensation |
$368.12
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
|
|
UNLISTED PROCEDURE PELVIS/HIP JOINT
|
Facility
|
OP
|
$2,157.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
6127299
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$2,049.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,294.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$1,294.20
|
| Rate for Payer: Cash Price |
$1,294.20
|
| Rate for Payer: Cigna Commercial |
$1,833.45
|
| Rate for Payer: First Health Commercial |
$1,941.30
|
| Rate for Payer: First Health Workers Compensation |
$832.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,941.30
|
| Rate for Payer: GEHA Commercial |
$1,725.60
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,941.30
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$1,962.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,509.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,941.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,049.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$1,617.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,006.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$862.80
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$588.86
|
|
|
UNLISTED PROCEDURE PELVIS/HIP JOINT
|
Facility
|
IP
|
$2,157.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
6127299
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$588.86 |
| Max. Negotiated Rate |
$2,049.15 |
| Rate for Payer: Cash Price |
$1,294.20
|
| Rate for Payer: Cigna Commercial |
$1,833.45
|
| Rate for Payer: First Health Commercial |
$1,941.30
|
| Rate for Payer: First Health Workers Compensation |
$832.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,941.30
|
| Rate for Payer: GEHA Commercial |
$1,509.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,941.30
|
| Rate for Payer: Multiplan All |
$1,962.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,509.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,941.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,049.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,617.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,006.01
|
| Rate for Payer: Zelis Auto |
$862.80
|
| Rate for Payer: Zelis Worker's Compensation |
$588.86
|
|
|
UNLISTED PROCEDURE TRACHEA BRONCHI
|
Facility
|
IP
|
$4,588.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
4031899
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,252.52 |
| Max. Negotiated Rate |
$4,358.60 |
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cigna Commercial |
$3,899.80
|
| Rate for Payer: First Health Commercial |
$4,129.20
|
| Rate for Payer: First Health Workers Compensation |
$1,771.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,129.20
|
| Rate for Payer: GEHA Commercial |
$3,211.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,129.20
|
| Rate for Payer: Multiplan All |
$4,175.08
|
| Rate for Payer: OMNI Networks Commercial |
$3,211.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,129.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,358.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,266.84
|
| Rate for Payer: Zelis Auto |
$1,835.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,252.52
|
|
|
UNLISTED PROCEDURE TRACHEA BRONCHI
|
Facility
|
OP
|
$4,588.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
4031899
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$4,358.60 |
| 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 |
$2,752.80
|
| 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 |
$188.12
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cigna Commercial |
$3,899.80
|
| Rate for Payer: First Health Commercial |
$4,129.20
|
| Rate for Payer: First Health Workers Compensation |
$1,771.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,129.20
|
| Rate for Payer: GEHA Commercial |
$3,670.40
|
| Rate for Payer: GEHA Medicare |
$188.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,129.20
|
| Rate for Payer: Humana ChoiceCare |
$206.93
|
| Rate for Payer: Humana Medicare Advantage |
$188.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.12
|
| Rate for Payer: Multiplan All |
$4,175.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$319.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,211.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,129.20
|
| 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 |
$188.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,358.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$376.24
|
| Rate for Payer: Three Rivers Provider Network All |
$3,441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.36
|
| Rate for Payer: United Healthcare Commercial |
$3,899.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,266.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.12
|
| Rate for Payer: Zelis Auto |
$1,835.20
|
| Rate for Payer: Zelis Medicare |
$159.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$225.74
|
| Rate for Payer: Zelis Worker's Compensation |
$1,252.52
|
|
|
UNLISTED PROCEDURE URINARY SYSTEM
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
6153899
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.77 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,218.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$235.67
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: First Health Workers Compensation |
$783.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,624.00
|
| Rate for Payer: GEHA Medicare |
$235.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Humana ChoiceCare |
$259.24
|
| Rate for Payer: Humana Medicare Advantage |
$235.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$395.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$235.67
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$400.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$235.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$471.34
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$230.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$235.67
|
| Rate for Payer: Zelis Auto |
$812.00
|
| Rate for Payer: Zelis Medicare |
$200.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$282.80
|
| Rate for Payer: Zelis Worker's Compensation |
$554.19
|
|
|
UNLISTED PROCEDURE URINARY SYSTEM
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
6153899
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$554.19 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: First Health Workers Compensation |
$783.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,421.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: Zelis Auto |
$812.00
|
| Rate for Payer: Zelis Worker's Compensation |
$554.19
|
|
|
UNLISTED PROCEDURE VASCULAR SURGERY
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
337799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.42 |
| Max. Negotiated Rate |
$1,793.60 |
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cigna Commercial |
$1,604.80
|
| Rate for Payer: First Health Commercial |
$1,699.20
|
| Rate for Payer: First Health Workers Compensation |
$728.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,699.20
|
| Rate for Payer: GEHA Commercial |
$1,321.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,699.20
|
| Rate for Payer: Multiplan All |
$1,718.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,321.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,699.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,793.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,416.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,755.84
|
| Rate for Payer: Zelis Auto |
$755.20
|
| Rate for Payer: Zelis Worker's Compensation |
$515.42
|
|
|
UNLISTED PROCEDURE VASCULAR SURGERY
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
6137799
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$509.22 |
| Max. Negotiated Rate |
$1,793.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,293.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,132.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,293.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,024.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$599.08
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cigna Commercial |
$1,604.80
|
| Rate for Payer: First Health Commercial |
$1,699.20
|
| Rate for Payer: First Health Workers Compensation |
$728.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,699.20
|
| Rate for Payer: GEHA Commercial |
$1,510.40
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,699.20
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,045.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$1,718.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,321.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,699.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,207.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,045.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,793.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$1,416.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,045.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,755.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$755.20
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$515.42
|
|
|
UNLISTED PROCEDURE VASCULAR SURGERY
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
6137799
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$515.42 |
| Max. Negotiated Rate |
$1,793.60 |
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cigna Commercial |
$1,604.80
|
| Rate for Payer: First Health Commercial |
$1,699.20
|
| Rate for Payer: First Health Workers Compensation |
$728.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,699.20
|
| Rate for Payer: GEHA Commercial |
$1,321.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,699.20
|
| Rate for Payer: Multiplan All |
$1,718.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,321.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,699.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,793.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,416.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,755.84
|
| Rate for Payer: Zelis Auto |
$755.20
|
| Rate for Payer: Zelis Worker's Compensation |
$515.42
|
|
|
UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
9599251
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.87
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: GEHA Medicare |
$28.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$31.76
|
| Rate for Payer: Humana Medicare Advantage |
$28.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$48.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.87
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.08
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$57.74
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.87
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Medicare |
$24.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.64
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
9599251
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
UNLISTED PX ABDOMEN MUSCULOSKELETAL SYST
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 22999
|
| Hospital Charge Code |
6122999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$2,225.91 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
UNLISTED PX ABDOMEN MUSCULOSKELETAL SYST
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 22999
|
| Hospital Charge Code |
6122999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
UPPER ENDO SCREENING
|
Facility
|
OP
|
$4,060.00
|
|
| Hospital Charge Code |
6180045
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$1,567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$3,248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Humana ChoiceCare |
$1,055.60
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,436.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,572.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,015.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,030.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,108.38
|
|
|
UPPER ENDO SCREENING
|
Facility
|
IP
|
$4,060.00
|
|
| Hospital Charge Code |
6180045
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,108.38 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$1,567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$2,842.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,108.38
|
|
|
UPPER ENDO WITH PROCEDURE
|
Facility
|
OP
|
$5,684.00
|
|
| Hospital Charge Code |
6180047
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$5,399.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,410.40
|
| Rate for Payer: Cash Price |
$3,410.40
|
| Rate for Payer: Cigna Commercial |
$4,831.40
|
| Rate for Payer: First Health Commercial |
$5,115.60
|
| Rate for Payer: First Health Workers Compensation |
$2,194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,115.60
|
| Rate for Payer: GEHA Commercial |
$4,547.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,115.60
|
| Rate for Payer: Humana ChoiceCare |
$1,477.84
|
| Rate for Payer: Multiplan All |
$5,172.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,410.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,978.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,115.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,399.80
|
| Rate for Payer: Three Rivers Provider Network All |
$4,263.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,001.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,421.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,286.12
|
| Rate for Payer: Zelis Auto |
$2,273.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,842.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,551.73
|
|
|
UPPER ENDO WITH PROCEDURE
|
Facility
|
IP
|
$5,684.00
|
|
| Hospital Charge Code |
6180047
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,551.73 |
| Max. Negotiated Rate |
$5,399.80 |
| Rate for Payer: Cash Price |
$3,410.40
|
| Rate for Payer: Cigna Commercial |
$4,831.40
|
| Rate for Payer: First Health Commercial |
$5,115.60
|
| Rate for Payer: First Health Workers Compensation |
$2,194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,115.60
|
| Rate for Payer: GEHA Commercial |
$3,978.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,115.60
|
| Rate for Payer: Multiplan All |
$5,172.44
|
| Rate for Payer: OMNI Networks Commercial |
$3,978.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,115.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,399.80
|
| Rate for Payer: Three Rivers Provider Network All |
$4,263.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,286.12
|
| Rate for Payer: Zelis Auto |
$2,273.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,551.73
|
|
|
UPPER GI ENDOSCOPY BIOPSY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
6143239
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
UPPER GI ENDOSCOPY BIOPSY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
6143239
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$1,816.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$908.48
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
UPPER GI ENDOSCOPY & INJECT
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
6143243
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$607.05 |
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$543.15
|
| Rate for Payer: First Health Commercial |
$575.10
|
| Rate for Payer: First Health Workers Compensation |
$246.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$575.10
|
| Rate for Payer: GEHA Commercial |
$447.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$575.10
|
| Rate for Payer: Multiplan All |
$581.49
|
| Rate for Payer: OMNI Networks Commercial |
$447.30
|
| Rate for Payer: One Health Plan PPO/POS |
$575.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$607.05
|
| Rate for Payer: Three Rivers Provider Network All |
$479.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$594.27
|
| Rate for Payer: Zelis Auto |
$255.60
|
| Rate for Payer: Zelis Worker's Compensation |
$174.45
|
|
