|
UPPER GI ENDOSCOPY & INJECT
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 43243
|
| Hospital Charge Code |
6143243
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$383.40
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$383.40
|
| 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 |
$511.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$575.10
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$581.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$447.30
|
| Rate for Payer: One Health Plan PPO/POS |
$575.10
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$607.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$479.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$594.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$255.60
|
| 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 |
$174.45
|
|
|
UPPER GI ENDOSCOPY/LIGATION
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
6143244
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$628.90 |
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$562.70
|
| Rate for Payer: First Health Commercial |
$595.80
|
| Rate for Payer: First Health Workers Compensation |
$255.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$595.80
|
| Rate for Payer: GEHA Commercial |
$463.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$595.80
|
| Rate for Payer: Multiplan All |
$602.42
|
| Rate for Payer: OMNI Networks Commercial |
$463.40
|
| Rate for Payer: One Health Plan PPO/POS |
$595.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$628.90
|
| Rate for Payer: Three Rivers Provider Network All |
$496.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$615.66
|
| Rate for Payer: Zelis Auto |
$264.80
|
| Rate for Payer: Zelis Worker's Compensation |
$180.73
|
|
|
UPPER GI ENDOSCOPY/LIGATION
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT 43244
|
| Hospital Charge Code |
6143244
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.73 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$397.20
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$562.70
|
| Rate for Payer: First Health Commercial |
$595.80
|
| Rate for Payer: First Health Workers Compensation |
$255.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$595.80
|
| Rate for Payer: GEHA Commercial |
$529.60
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$595.80
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$602.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$463.40
|
| Rate for Payer: One Health Plan PPO/POS |
$595.80
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$628.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$496.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$615.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$264.80
|
| 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 |
$180.73
|
|
|
UPPER GI ENDOSCOPY/TUMOR
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
6143250
|
|
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
|
|
|
UPPER GI ENDOSCOPY/TUMOR
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
6143250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$326.40
|
| 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 |
$1,801.27
|
| 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 |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| 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 |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$217.60
|
| 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 |
$148.51
|
|
|
UPPER GI ENDOSCOPY WITH TUBE
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
6143241
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$180.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$327.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| Rate for Payer: Multiplan All |
$425.88
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.24
|
| Rate for Payer: Zelis Auto |
$187.20
|
| Rate for Payer: Zelis Worker's Compensation |
$127.76
|
|
|
UPPER GI ENDOSCOPY WITH TUBE
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
6143241
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$280.80
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$180.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$374.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$425.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$187.20
|
| 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 |
$127.76
|
|
|
UPPR GI ENDOSCOPY DIAGNOSIS
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
6143235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$106.47 |
| Max. Negotiated Rate |
$1,780.50 |
| 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 |
$234.00
|
| 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 |
$890.25
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$331.50
|
| Rate for Payer: First Health Commercial |
$351.00
|
| Rate for Payer: First Health Workers Compensation |
$150.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.00
|
| Rate for Payer: GEHA Commercial |
$312.00
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.00
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$354.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$273.00
|
| Rate for Payer: One Health Plan PPO/POS |
$351.00
|
| 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 |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$370.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$292.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$362.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$156.00
|
| 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 |
$106.47
|
|
|
UPPR GI ENDOSCOPY DIAGNOSIS
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
6143235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$106.47 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$331.50
|
| Rate for Payer: First Health Commercial |
$351.00
|
| Rate for Payer: First Health Workers Compensation |
$150.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.00
|
| Rate for Payer: GEHA Commercial |
$273.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.00
|
| Rate for Payer: Multiplan All |
$354.90
|
| Rate for Payer: OMNI Networks Commercial |
$273.00
|
| Rate for Payer: One Health Plan PPO/POS |
$351.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$370.50
|
| Rate for Payer: Three Rivers Provider Network All |
$292.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$362.70
|
| Rate for Payer: Zelis Auto |
$156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$106.47
|
|
|
UPPR GI ENDOSCOPY/GUIDE WIRE
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
6143248
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$1,780.50 |
| 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 |
$325.20
|
| 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 |
$890.25
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$209.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| 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 |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$216.80
|
| 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 |
$147.97
|
|
|
UPPR GI ENDOSCOPY/GUIDE WIRE
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
6143248
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$209.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Worker's Compensation |
$147.97
|
|
|
UPPR GI ENDOSCOPY W/US FN BX
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
6143238
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$376.20
|
| 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 |
$1,801.27
|
| 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 |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| 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 |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$250.80
|
| 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 |
$171.17
|
|
|
UPPR GI ENDOSCOPY W/US FN BX
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
6143238
|
|
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
|
|
|
UPPR GI ENDOSCOPY W/US FN BX
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
6143242
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.28 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$424.80
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$601.80
|
| Rate for Payer: First Health Commercial |
$637.20
|
| Rate for Payer: First Health Workers Compensation |
$273.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$637.20
|
| Rate for Payer: GEHA Commercial |
$566.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$637.20
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$644.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$495.60
|
| Rate for Payer: One Health Plan PPO/POS |
$637.20
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$672.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$531.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$658.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$283.20
|
| 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 |
$193.28
|
|
|
UPPR GI ENDOSCOPY W/US FN BX
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
6143242
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.28 |
| Max. Negotiated Rate |
$672.60 |
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna Commercial |
$601.80
|
| Rate for Payer: First Health Commercial |
$637.20
|
| Rate for Payer: First Health Workers Compensation |
$273.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$637.20
|
| Rate for Payer: GEHA Commercial |
$495.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$637.20
|
| Rate for Payer: Multiplan All |
$644.28
|
| Rate for Payer: OMNI Networks Commercial |
$495.60
|
| Rate for Payer: One Health Plan PPO/POS |
$637.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$672.60
|
| Rate for Payer: Three Rivers Provider Network All |
$531.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$658.44
|
| Rate for Payer: Zelis Auto |
$283.20
|
| Rate for Payer: Zelis Worker's Compensation |
$193.28
|
|
|
UPPR GI OPTICL ENDOMICRSCOPY
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
6143252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.88 |
| Max. Negotiated Rate |
$521.55 |
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna Commercial |
$466.65
|
| Rate for Payer: First Health Commercial |
$494.10
|
| Rate for Payer: First Health Workers Compensation |
$211.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$494.10
|
| Rate for Payer: GEHA Commercial |
$384.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$494.10
|
| Rate for Payer: Multiplan All |
$499.59
|
| Rate for Payer: OMNI Networks Commercial |
$384.30
|
| Rate for Payer: One Health Plan PPO/POS |
$494.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$521.55
|
| Rate for Payer: Three Rivers Provider Network All |
$411.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$510.57
|
| Rate for Payer: Zelis Auto |
$219.60
|
| Rate for Payer: Zelis Worker's Compensation |
$149.88
|
|
|
UPPR GI OPTICL ENDOMICRSCOPY
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
6143252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.88 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,314.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$329.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,314.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,040.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna Commercial |
$466.65
|
| Rate for Payer: First Health Commercial |
$494.10
|
| Rate for Payer: First Health Workers Compensation |
$211.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$494.10
|
| Rate for Payer: GEHA Commercial |
$439.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$494.10
|
| 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 |
$1,062.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$499.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$384.30
|
| Rate for Payer: One Health Plan PPO/POS |
$494.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,226.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,062.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$521.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$411.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,062.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$510.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$219.60
|
| 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 |
$149.88
|
|
|
UPPR GI SCOPE DILATE STRICTR
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
6143245
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$401.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: Zelis Auto |
$229.60
|
| Rate for Payer: Zelis Worker's Compensation |
$156.70
|
|
|
UPPR GI SCOPE DILATE STRICTR
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
6143245
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$344.40
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$229.60
|
| 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 |
$156.70
|
|
|
UPPR GI SCOPE W/SUBMUC INJ
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
6143236
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$1,780.50 |
| 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 |
$273.00
|
| 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 |
$890.25
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| 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 |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$182.00
|
| 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 |
$124.22
|
|
|
UPPR GI SCOPE W/SUBMUC INJ
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
6143236
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$386.75
|
| Rate for Payer: First Health Commercial |
$409.50
|
| Rate for Payer: First Health Workers Compensation |
$175.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$409.50
|
| Rate for Payer: GEHA Commercial |
$318.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: OMNI Networks Commercial |
$318.50
|
| Rate for Payer: One Health Plan PPO/POS |
$409.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
UREACREAM 40%
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 16477034003
|
| Hospital Charge Code |
3300931
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.81 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: First Health Workers Compensation |
$110.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$199.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$77.81
|
|
|
UREACREAM 40%
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 16477034003
|
| Hospital Charge Code |
3300931
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: First Health Workers Compensation |
$110.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$256.50
|
| Rate for Payer: GEHA Commercial |
$228.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$256.50
|
| Rate for Payer: Humana ChoiceCare |
$74.10
|
| Rate for Payer: Multiplan All |
$259.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.00
|
| Rate for Payer: OMNI Networks Commercial |
$199.50
|
| Rate for Payer: One Health Plan PPO/POS |
$256.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$270.75
|
| Rate for Payer: Three Rivers Provider Network All |
$213.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$250.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$265.05
|
| Rate for Payer: Zelis Auto |
$114.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$142.50
|
| Rate for Payer: Zelis Worker's Compensation |
$77.81
|
|
|
urea nitrogen 24hr urine REF003541
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
2299645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
|
urea nitrogen 24hr urine REF003541
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
2299645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$5.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$6.12
|
| Rate for Payer: Humana Medicare Advantage |
$5.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.56
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.45
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.12
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.45
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.56
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$4.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.67
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
