|
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERV
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
6157460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$448.20
|
| Rate for Payer: First Health Workers Compensation |
$192.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$448.20
|
| Rate for Payer: GEHA Commercial |
$398.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$448.20
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$453.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$348.60
|
| Rate for Payer: One Health Plan PPO/POS |
$448.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$473.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$373.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$463.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$199.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$135.95
|
|
|
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERV
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
6157460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$473.10 |
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$448.20
|
| Rate for Payer: First Health Workers Compensation |
$192.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$448.20
|
| Rate for Payer: GEHA Commercial |
$348.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$448.20
|
| Rate for Payer: Multiplan All |
$453.18
|
| Rate for Payer: OMNI Networks Commercial |
$348.60
|
| Rate for Payer: One Health Plan PPO/POS |
$448.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$473.10
|
| Rate for Payer: Three Rivers Provider Network All |
$373.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$463.14
|
| Rate for Payer: Zelis Auto |
$199.20
|
| Rate for Payer: Zelis Worker's Compensation |
$135.95
|
|
|
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERV
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
23500041
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$473.10 |
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$448.20
|
| Rate for Payer: First Health Workers Compensation |
$192.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$448.20
|
| Rate for Payer: GEHA Commercial |
$348.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$448.20
|
| Rate for Payer: Multiplan All |
$453.18
|
| Rate for Payer: OMNI Networks Commercial |
$348.60
|
| Rate for Payer: One Health Plan PPO/POS |
$448.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$473.10
|
| Rate for Payer: Three Rivers Provider Network All |
$373.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$463.14
|
| Rate for Payer: Zelis Auto |
$199.20
|
| Rate for Payer: Zelis Worker's Compensation |
$135.95
|
|
|
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERV
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
23500041
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$448.20
|
| Rate for Payer: First Health Workers Compensation |
$192.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$448.20
|
| Rate for Payer: GEHA Commercial |
$398.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$448.20
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$453.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$348.60
|
| Rate for Payer: One Health Plan PPO/POS |
$448.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$473.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$373.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$463.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$199.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$135.95
|
|
|
COLPOSCOPY ENTIRE VAG W/VAGINA/CERVIX BX
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
6157421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$1,653.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$273.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$826.80
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$328.10
|
| Rate for Payer: First Health Commercial |
$347.40
|
| Rate for Payer: First Health Workers Compensation |
$149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$347.40
|
| Rate for Payer: GEHA Commercial |
$308.80
|
| Rate for Payer: GEHA Medicare |
$826.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$347.40
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Humana Medicare Advantage |
$826.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,389.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$278.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$826.80
|
| Rate for Payer: Multiplan All |
$351.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,405.56
|
| Rate for Payer: OMNI Networks Commercial |
$270.20
|
| Rate for Payer: One Health Plan PPO/POS |
$347.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$321.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$278.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$826.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$366.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,653.60
|
| Rate for Payer: Three Rivers Provider Network All |
$289.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$810.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$826.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$826.80
|
| Rate for Payer: Zelis Auto |
$154.40
|
| Rate for Payer: Zelis Medicare |
$702.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$992.16
|
| Rate for Payer: Zelis Worker's Compensation |
$105.38
|
|
|
COLPOSCOPY ENTIRE VAG W/VAGINA/CERVIX BX
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
23557421
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$1,653.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$273.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$826.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$448.20
|
| Rate for Payer: First Health Workers Compensation |
$192.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$448.20
|
| Rate for Payer: GEHA Commercial |
$398.40
|
| Rate for Payer: GEHA Medicare |
$826.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$448.20
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Humana Medicare Advantage |
$826.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,389.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$278.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$826.80
|
| Rate for Payer: Multiplan All |
$453.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,405.56
|
| Rate for Payer: OMNI Networks Commercial |
$348.60
|
| Rate for Payer: One Health Plan PPO/POS |
$448.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$321.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$278.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$826.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$473.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,653.60
|
| Rate for Payer: Three Rivers Provider Network All |
$373.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$810.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$278.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$826.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$463.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$826.80
|
| Rate for Payer: Zelis Auto |
$199.20
|
| Rate for Payer: Zelis Medicare |
$702.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$992.16
|
| Rate for Payer: Zelis Worker's Compensation |
$135.95
|
|
|
COLPOSCOPY ENTIRE VAG W/VAGINA/CERVIX BX
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
23557421
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$473.10 |
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$448.20
|
| Rate for Payer: First Health Workers Compensation |
$192.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$448.20
|
| Rate for Payer: GEHA Commercial |
$348.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$448.20
|
| Rate for Payer: Multiplan All |
$453.18
|
| Rate for Payer: OMNI Networks Commercial |
$348.60
|
| Rate for Payer: One Health Plan PPO/POS |
$448.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$473.10
|
| Rate for Payer: Three Rivers Provider Network All |
$373.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$463.14
|
| Rate for Payer: Zelis Auto |
$199.20
|
| Rate for Payer: Zelis Worker's Compensation |
$135.95
|
|
|
COLPOSCOPY ENTIRE VAG W/VAGINA/CERVIX BX
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
6157421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$328.10
|
| Rate for Payer: First Health Commercial |
$347.40
|
| Rate for Payer: First Health Workers Compensation |
$149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$347.40
|
| Rate for Payer: GEHA Commercial |
$270.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$347.40
|
| Rate for Payer: Multiplan All |
$351.26
|
| Rate for Payer: OMNI Networks Commercial |
$270.20
|
| Rate for Payer: One Health Plan PPO/POS |
$347.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$366.70
|
| Rate for Payer: Three Rivers Provider Network All |
$289.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.98
|
| Rate for Payer: Zelis Auto |
$154.40
|
| Rate for Payer: Zelis Worker's Compensation |
$105.38
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX
|
Facility
|
OP
|
$6,038.18
|
|
|
Service Code
|
CPT 57461
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,605.60 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: First Health Workers Compensation |
$3,885.57
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$2,747.37
|
|
|
COLSC FLX W/REMOVAL LESION BY HOT BX FOR
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
7645384
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$346.44 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: First Health Workers Compensation |
$489.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Worker's Compensation |
$346.44
|
|
|
COLSC FLX W/REMOVAL LESION BY HOT BX FOR
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
6145384
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.44 |
| 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 |
$761.40
|
| 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 |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: First Health Workers Compensation |
$489.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| 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 |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| 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 |
$1,205.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| 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 |
$1,180.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$507.60
|
| 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 |
$346.44
|
|
|
COLSC FLX W/REMOVAL LESION BY HOT BX FOR
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
7645384
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$346.44 |
| 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 |
$761.40
|
| 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 |
$761.40
|
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: First Health Workers Compensation |
$489.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$1,015.20
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| 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 |
$1,154.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| 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 |
$1,205.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| 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 |
$1,180.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$507.60
|
| 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 |
$346.44
|
|
|
COLSC FLX W/REMOVAL LESION BY HOT BX FOR
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
6145384
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.44 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Cash Price |
$761.40
|
| Rate for Payer: Cigna Commercial |
$1,078.65
|
| Rate for Payer: First Health Commercial |
$1,142.10
|
| Rate for Payer: First Health Workers Compensation |
$489.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,142.10
|
| Rate for Payer: GEHA Commercial |
$888.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,142.10
|
| Rate for Payer: Multiplan All |
$1,154.79
|
| Rate for Payer: OMNI Networks Commercial |
$888.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,142.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,205.55
|
| Rate for Payer: Three Rivers Provider Network All |
$951.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,180.17
|
| Rate for Payer: Zelis Auto |
$507.60
|
| Rate for Payer: Zelis Worker's Compensation |
$346.44
|
|
|
COMBINATION ORAL/NASAL MASK
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7027
|
| Hospital Charge Code |
3000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$95.55
|
|
|
COMBINATION ORAL/NASAL MASK
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7027
|
| Hospital Charge Code |
3000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Humana ChoiceCare |
$91.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$210.00
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$308.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$175.00
|
| Rate for Payer: Zelis Worker's Compensation |
$95.55
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 57260
|
|
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
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED; WITH ENTEROCELE REPAIR
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,603.59 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| 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 |
$3,676.98
|
| 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 |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| 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 |
$3,676.98
|
| 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
|
|
|
COMBO UPPER AND LOWER ENDO NO PROCEDURE
|
Facility
|
OP
|
$8,120.00
|
|
| Hospital Charge Code |
6180049
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,030.00 |
| Max. Negotiated Rate |
$7,714.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,872.00
|
| Rate for Payer: Cash Price |
$4,872.00
|
| Rate for Payer: Cigna Commercial |
$6,902.00
|
| Rate for Payer: First Health Commercial |
$7,308.00
|
| Rate for Payer: First Health Workers Compensation |
$3,135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,308.00
|
| Rate for Payer: GEHA Commercial |
$6,496.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,308.00
|
| Rate for Payer: Humana ChoiceCare |
$2,111.20
|
| Rate for Payer: Multiplan All |
$7,389.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,872.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,684.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,308.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,714.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,090.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,030.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,551.60
|
| Rate for Payer: Zelis Auto |
$3,248.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,060.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,216.76
|
|
|
COMBO UPPER AND LOWER ENDO NO PROCEDURE
|
Facility
|
IP
|
$8,120.00
|
|
| Hospital Charge Code |
6180049
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,216.76 |
| Max. Negotiated Rate |
$7,714.00 |
| Rate for Payer: Cash Price |
$4,872.00
|
| Rate for Payer: Cigna Commercial |
$6,902.00
|
| Rate for Payer: First Health Commercial |
$7,308.00
|
| Rate for Payer: First Health Workers Compensation |
$3,135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,308.00
|
| Rate for Payer: GEHA Commercial |
$5,684.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,308.00
|
| Rate for Payer: Multiplan All |
$7,389.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,684.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,308.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,714.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,090.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,551.60
|
| Rate for Payer: Zelis Auto |
$3,248.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,216.76
|
|
|
COMBO UPPER AND LOWER ENDO W PROCEDURE
|
Facility
|
OP
|
$8,120.00
|
|
| Hospital Charge Code |
6180050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,030.00 |
| Max. Negotiated Rate |
$7,714.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,872.00
|
| Rate for Payer: Cash Price |
$4,872.00
|
| Rate for Payer: Cigna Commercial |
$6,902.00
|
| Rate for Payer: First Health Commercial |
$7,308.00
|
| Rate for Payer: First Health Workers Compensation |
$3,135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,308.00
|
| Rate for Payer: GEHA Commercial |
$6,496.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,308.00
|
| Rate for Payer: Humana ChoiceCare |
$2,111.20
|
| Rate for Payer: Multiplan All |
$7,389.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,872.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,684.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,308.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,714.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,090.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,030.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,551.60
|
| Rate for Payer: Zelis Auto |
$3,248.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,060.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,216.76
|
|
|
COMBO UPPER AND LOWER ENDO W PROCEDURE
|
Facility
|
IP
|
$8,120.00
|
|
| Hospital Charge Code |
6180050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,216.76 |
| Max. Negotiated Rate |
$7,714.00 |
| Rate for Payer: Cash Price |
$4,872.00
|
| Rate for Payer: Cigna Commercial |
$6,902.00
|
| Rate for Payer: First Health Commercial |
$7,308.00
|
| Rate for Payer: First Health Workers Compensation |
$3,135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,308.00
|
| Rate for Payer: GEHA Commercial |
$5,684.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,308.00
|
| Rate for Payer: Multiplan All |
$7,389.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,684.00
|
| Rate for Payer: One Health Plan PPO/POS |
$7,308.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,714.00
|
| Rate for Payer: Three Rivers Provider Network All |
$6,090.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,551.60
|
| Rate for Payer: Zelis Auto |
$3,248.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,216.76
|
|
|
common ragweed IgE REF602463
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
common ragweed IgE REF602463
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
COMP EXT FIXATE STRUT CHANGE
|
Facility
|
OP
|
$3,759.00
|
|
|
Service Code
|
CPT 20697
|
| Hospital Charge Code |
6120697
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,026.21 |
| Max. Negotiated Rate |
$3,571.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,255.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cigna Commercial |
$3,195.15
|
| Rate for Payer: First Health Commercial |
$3,383.10
|
| Rate for Payer: First Health Workers Compensation |
$1,451.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,383.10
|
| Rate for Payer: GEHA Commercial |
$3,007.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,383.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$3,420.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,631.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,383.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,571.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,819.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,495.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,503.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,026.21
|
|
|
COMP EXT FIXATE STRUT CHANGE
|
Facility
|
IP
|
$3,759.00
|
|
|
Service Code
|
CPT 20697
|
| Hospital Charge Code |
6120697
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,026.21 |
| Max. Negotiated Rate |
$3,571.05 |
| Rate for Payer: Cash Price |
$2,255.40
|
| Rate for Payer: Cigna Commercial |
$3,195.15
|
| Rate for Payer: First Health Commercial |
$3,383.10
|
| Rate for Payer: First Health Workers Compensation |
$1,451.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,383.10
|
| Rate for Payer: GEHA Commercial |
$2,631.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,383.10
|
| Rate for Payer: Multiplan All |
$3,420.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,631.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,383.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,571.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,819.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,495.87
|
| Rate for Payer: Zelis Auto |
$1,503.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,026.21
|
|
