|
COLONOSCOPY W/RESECTION THRU STOMA
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 44403
|
| Hospital Charge Code |
6144681
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,184.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,184.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$938.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$957.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,105.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$957.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$957.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
COLONOSCOPY W/RESECTION THRU STOMA
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 44403
|
| Hospital Charge Code |
6144681
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
COLONOSCOPY W/SNARE
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 44394
|
| Hospital Charge Code |
6144394
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$366.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cigna Commercial |
$519.35
|
| Rate for Payer: First Health Commercial |
$549.90
|
| Rate for Payer: First Health Workers Compensation |
$235.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.90
|
| Rate for Payer: GEHA Commercial |
$488.80
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.90
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$556.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$427.70
|
| Rate for Payer: One Health Plan PPO/POS |
$549.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$580.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$458.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$568.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$244.40
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$166.80
|
|
|
COLONOSCOPY W/SNARE
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 44394
|
| Hospital Charge Code |
6144394
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cigna Commercial |
$519.35
|
| Rate for Payer: First Health Commercial |
$549.90
|
| Rate for Payer: First Health Workers Compensation |
$235.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.90
|
| Rate for Payer: GEHA Commercial |
$427.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.90
|
| Rate for Payer: Multiplan All |
$556.01
|
| Rate for Payer: OMNI Networks Commercial |
$427.70
|
| Rate for Payer: One Health Plan PPO/POS |
$549.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$580.45
|
| Rate for Payer: Three Rivers Provider Network All |
$458.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$568.23
|
| Rate for Payer: Zelis Auto |
$244.40
|
| Rate for Payer: Zelis Worker's Compensation |
$166.80
|
|
|
COLOREC CANCR SCR;COLNSCPY BA ENEMA
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT G0120
|
| Hospital Charge Code |
8500120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$247.88 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: First Health Workers Compensation |
$350.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Worker's Compensation |
$247.88
|
|
|
COLOREC CANCR SCR;COLNSCPY BA ENEMA
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT G0120
|
| Hospital Charge Code |
8500120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$100.21 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$100.21
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: First Health Workers Compensation |
$350.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Humana ChoiceCare |
$236.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$102.25
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.80
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$118.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$102.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.00
|
| Rate for Payer: Zelis Worker's Compensation |
$247.88
|
|
|
COLOREC CANCR SCR; COLNSCPY HI RISK
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
8500105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$265.08 |
| Max. Negotiated Rate |
$922.45 |
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Cigna Commercial |
$825.35
|
| Rate for Payer: First Health Commercial |
$873.90
|
| Rate for Payer: First Health Workers Compensation |
$374.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.90
|
| Rate for Payer: GEHA Commercial |
$679.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.90
|
| Rate for Payer: Multiplan All |
$883.61
|
| Rate for Payer: OMNI Networks Commercial |
$679.70
|
| Rate for Payer: One Health Plan PPO/POS |
$873.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$922.45
|
| Rate for Payer: Three Rivers Provider Network All |
$728.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.03
|
| Rate for Payer: Zelis Auto |
$388.40
|
| Rate for Payer: Zelis Worker's Compensation |
$265.08
|
|
|
COLOREC CANCR SCR; COLNSCPY HI RISK
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
8500105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$265.08 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$582.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$648.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Cigna Commercial |
$825.35
|
| Rate for Payer: First Health Commercial |
$873.90
|
| Rate for Payer: First Health Workers Compensation |
$374.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.90
|
| Rate for Payer: GEHA Commercial |
$776.80
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.90
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$661.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$883.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$679.70
|
| Rate for Payer: One Health Plan PPO/POS |
$873.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$763.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$661.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$922.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$728.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$388.40
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$265.08
|
|
|
COLOREC CNCR SCR;COLNSCPY NO HI RSK
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
8500121
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$265.36 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cigna Commercial |
$826.20
|
| Rate for Payer: First Health Commercial |
$874.80
|
| Rate for Payer: First Health Workers Compensation |
$375.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$874.80
|
| Rate for Payer: GEHA Commercial |
$680.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$874.80
|
| Rate for Payer: Multiplan All |
$884.52
|
| Rate for Payer: OMNI Networks Commercial |
$680.40
|
| Rate for Payer: One Health Plan PPO/POS |
$874.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$923.40
|
| Rate for Payer: Three Rivers Provider Network All |
$729.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.96
|
| Rate for Payer: Zelis Auto |
$388.80
|
| Rate for Payer: Zelis Worker's Compensation |
$265.36
|
|
|
COLOREC CNCR SCR;COLNSCPY NO HI RSK
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
8500121
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$265.36 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$648.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cigna Commercial |
$826.20
|
| Rate for Payer: First Health Commercial |
$874.80
|
| Rate for Payer: First Health Workers Compensation |
$375.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$874.80
|
| Rate for Payer: GEHA Commercial |
$777.60
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$874.80
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$661.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$884.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$680.40
|
| Rate for Payer: One Health Plan PPO/POS |
$874.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$763.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$661.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$923.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$729.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$388.80
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$265.36
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
|
Facility
|
OP
|
$1,731.42
|
|
|
Service Code
|
CPT G0105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$648.10 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$648.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$661.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$763.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$661.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$1,731.42
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$648.10 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$648.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$661.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$763.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$661.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
|
|
COLORECTAL CANCER SCREENING/NOT HI RISK
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
20300088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.36 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$648.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cigna Commercial |
$826.20
|
| Rate for Payer: First Health Commercial |
$874.80
|
| Rate for Payer: First Health Workers Compensation |
$375.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$874.80
|
| Rate for Payer: GEHA Commercial |
$777.60
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$874.80
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$661.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$884.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$680.40
|
| Rate for Payer: One Health Plan PPO/POS |
$874.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$763.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$661.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$923.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$729.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$388.80
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$265.36
|
|
|
COLORECTAL CANCER SCREENING/NOT HI RISK
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
20300088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.36 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cigna Commercial |
$826.20
|
| Rate for Payer: First Health Commercial |
$874.80
|
| Rate for Payer: First Health Workers Compensation |
$375.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$874.80
|
| Rate for Payer: GEHA Commercial |
$680.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$874.80
|
| Rate for Payer: Multiplan All |
$884.52
|
| Rate for Payer: OMNI Networks Commercial |
$680.40
|
| Rate for Payer: One Health Plan PPO/POS |
$874.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$923.40
|
| Rate for Payer: Three Rivers Provider Network All |
$729.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.96
|
| Rate for Payer: Zelis Auto |
$388.80
|
| Rate for Payer: Zelis Worker's Compensation |
$265.36
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
6100105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$560.50 |
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$501.50
|
| Rate for Payer: First Health Commercial |
$531.00
|
| Rate for Payer: First Health Workers Compensation |
$227.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.00
|
| Rate for Payer: GEHA Commercial |
$413.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.00
|
| Rate for Payer: Multiplan All |
$536.90
|
| Rate for Payer: OMNI Networks Commercial |
$413.00
|
| Rate for Payer: One Health Plan PPO/POS |
$531.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$560.50
|
| Rate for Payer: Three Rivers Provider Network All |
$442.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$548.70
|
| Rate for Payer: Zelis Auto |
$236.00
|
| Rate for Payer: Zelis Worker's Compensation |
$161.07
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
20300087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.08 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$582.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$648.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Cigna Commercial |
$825.35
|
| Rate for Payer: First Health Commercial |
$873.90
|
| Rate for Payer: First Health Workers Compensation |
$374.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.90
|
| Rate for Payer: GEHA Commercial |
$776.80
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.90
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$661.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$883.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$679.70
|
| Rate for Payer: One Health Plan PPO/POS |
$873.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$763.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$661.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$922.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$728.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$388.40
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$265.08
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
20300087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.08 |
| Max. Negotiated Rate |
$922.45 |
| Rate for Payer: Cash Price |
$582.60
|
| Rate for Payer: Cigna Commercial |
$825.35
|
| Rate for Payer: First Health Commercial |
$873.90
|
| Rate for Payer: First Health Workers Compensation |
$374.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.90
|
| Rate for Payer: GEHA Commercial |
$679.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.90
|
| Rate for Payer: Multiplan All |
$883.61
|
| Rate for Payer: OMNI Networks Commercial |
$679.70
|
| Rate for Payer: One Health Plan PPO/POS |
$873.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$922.45
|
| Rate for Payer: Three Rivers Provider Network All |
$728.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$903.03
|
| Rate for Payer: Zelis Auto |
$388.40
|
| Rate for Payer: Zelis Worker's Compensation |
$265.08
|
|
|
COLORECTAL SCRN; HI RISK IND
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
6100105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$354.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$818.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$648.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$501.50
|
| Rate for Payer: First Health Commercial |
$531.00
|
| Rate for Payer: First Health Workers Compensation |
$227.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.00
|
| Rate for Payer: GEHA Commercial |
$472.00
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.00
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$661.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$536.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$413.00
|
| Rate for Payer: One Health Plan PPO/POS |
$531.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$763.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$661.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$560.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$442.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$661.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$548.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$236.00
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$161.07
|
|
|
COLOSTOMY
|
Facility
|
IP
|
$2,523.00
|
|
|
Service Code
|
CPT 44320
|
| Hospital Charge Code |
6144320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$688.78 |
| Max. Negotiated Rate |
$2,396.85 |
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Cigna Commercial |
$2,144.55
|
| Rate for Payer: First Health Commercial |
$2,270.70
|
| Rate for Payer: First Health Workers Compensation |
$974.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,270.70
|
| Rate for Payer: GEHA Commercial |
$1,766.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,270.70
|
| Rate for Payer: Multiplan All |
$2,295.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,270.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,396.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,892.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,346.39
|
| Rate for Payer: Zelis Auto |
$1,009.20
|
| Rate for Payer: Zelis Worker's Compensation |
$688.78
|
|
|
COLOSTOMY
|
Facility
|
OP
|
$2,523.00
|
|
|
Service Code
|
CPT 44320
|
| Hospital Charge Code |
6144320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$630.75 |
| Max. Negotiated Rate |
$2,396.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,513.80
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Cigna Commercial |
$2,144.55
|
| Rate for Payer: First Health Commercial |
$2,270.70
|
| Rate for Payer: First Health Workers Compensation |
$974.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,270.70
|
| Rate for Payer: GEHA Commercial |
$2,018.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,270.70
|
| Rate for Payer: Humana ChoiceCare |
$655.98
|
| Rate for Payer: Multiplan All |
$2,295.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,270.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,396.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,892.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,220.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$630.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,346.39
|
| Rate for Payer: Zelis Auto |
$1,009.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,261.50
|
| Rate for Payer: Zelis Worker's Compensation |
$688.78
|
|
|
COLOSTOMY WITH BIOPSIES
|
Facility
|
IP
|
$2,069.00
|
|
|
Service Code
|
CPT 44322
|
| Hospital Charge Code |
6144322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$564.84 |
| Max. Negotiated Rate |
$1,965.55 |
| Rate for Payer: Cash Price |
$1,241.40
|
| Rate for Payer: Cigna Commercial |
$1,758.65
|
| Rate for Payer: First Health Commercial |
$1,862.10
|
| Rate for Payer: First Health Workers Compensation |
$798.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,862.10
|
| Rate for Payer: GEHA Commercial |
$1,448.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,862.10
|
| Rate for Payer: Multiplan All |
$1,882.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,448.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,862.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,965.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,551.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,924.17
|
| Rate for Payer: Zelis Auto |
$827.60
|
| Rate for Payer: Zelis Worker's Compensation |
$564.84
|
|
|
COLOSTOMY WITH BIOPSIES
|
Facility
|
OP
|
$2,069.00
|
|
|
Service Code
|
CPT 44322
|
| Hospital Charge Code |
6144322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$517.25 |
| Max. Negotiated Rate |
$1,965.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,241.40
|
| Rate for Payer: Cash Price |
$1,241.40
|
| Rate for Payer: Cigna Commercial |
$1,758.65
|
| Rate for Payer: First Health Commercial |
$1,862.10
|
| Rate for Payer: First Health Workers Compensation |
$798.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,862.10
|
| Rate for Payer: GEHA Commercial |
$1,655.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,862.10
|
| Rate for Payer: Humana ChoiceCare |
$537.94
|
| Rate for Payer: Multiplan All |
$1,882.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,241.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,448.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,862.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,965.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,551.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,820.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$517.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,924.17
|
| Rate for Payer: Zelis Auto |
$827.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,034.50
|
| Rate for Payer: Zelis Worker's Compensation |
$564.84
|
|
|
COLPOCLEISIS (LE FORT TYPE)
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 57120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,824.80 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: First Health Workers Compensation |
$6,032.63
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4,265.50
|
|
|
COLPOCLEISIS LE FORT TYPE
|
Facility
|
OP
|
$1,566.48
|
|
|
Service Code
|
CPT 57120
|
| Hospital Charge Code |
6157120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.65 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$939.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$939.89
|
| Rate for Payer: Cash Price |
$939.89
|
| Rate for Payer: Cigna Commercial |
$1,331.51
|
| Rate for Payer: First Health Commercial |
$1,409.83
|
| Rate for Payer: First Health Workers Compensation |
$604.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,409.83
|
| Rate for Payer: GEHA Commercial |
$1,253.18
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,409.83
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,425.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.54
|
| Rate for Payer: One Health Plan PPO/POS |
$1,409.83
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,488.16
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,174.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,456.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$626.59
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$427.65
|
|
|
COLPOCLEISIS LE FORT TYPE
|
Facility
|
IP
|
$1,566.48
|
|
|
Service Code
|
CPT 57120
|
| Hospital Charge Code |
6157120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.65 |
| Max. Negotiated Rate |
$1,488.16 |
| Rate for Payer: Cash Price |
$939.89
|
| Rate for Payer: Cigna Commercial |
$1,331.51
|
| Rate for Payer: First Health Commercial |
$1,409.83
|
| Rate for Payer: First Health Workers Compensation |
$604.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,409.83
|
| Rate for Payer: GEHA Commercial |
$1,096.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,409.83
|
| Rate for Payer: Multiplan All |
$1,425.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.54
|
| Rate for Payer: One Health Plan PPO/POS |
$1,409.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,488.16
|
| Rate for Payer: Three Rivers Provider Network All |
$1,174.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,456.83
|
| Rate for Payer: Zelis Auto |
$626.59
|
| Rate for Payer: Zelis Worker's Compensation |
$427.65
|
|
