|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
6130901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
8130901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| 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 |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| 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 |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$409.50
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$414.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| 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 |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$432.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$341.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$423.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$182.00
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$124.22
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
8300043
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
8300043
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$229.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
6130901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$243.95
|
| Rate for Payer: First Health Commercial |
$258.30
|
| Rate for Payer: First Health Workers Compensation |
$110.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$258.30
|
| Rate for Payer: GEHA Commercial |
$200.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$258.30
|
| Rate for Payer: Multiplan All |
$261.17
|
| Rate for Payer: OMNI Networks Commercial |
$200.90
|
| Rate for Payer: One Health Plan PPO/POS |
$258.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$272.65
|
| Rate for Payer: Three Rivers Provider Network All |
$215.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$266.91
|
| Rate for Payer: Zelis Auto |
$114.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.35
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 42971
|
| Hospital Charge Code |
6142971
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$803.25
|
| Rate for Payer: First Health Commercial |
$850.50
|
| Rate for Payer: First Health Workers Compensation |
$364.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$850.50
|
| Rate for Payer: GEHA Commercial |
$661.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$850.50
|
| Rate for Payer: Multiplan All |
$859.95
|
| Rate for Payer: OMNI Networks Commercial |
$661.50
|
| Rate for Payer: One Health Plan PPO/POS |
$850.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$897.75
|
| Rate for Payer: Three Rivers Provider Network All |
$708.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$878.85
|
| Rate for Payer: Zelis Auto |
$378.00
|
| Rate for Payer: Zelis Worker's Compensation |
$257.99
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 42971
|
| Hospital Charge Code |
6142971
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$803.25
|
| Rate for Payer: First Health Commercial |
$850.50
|
| Rate for Payer: First Health Workers Compensation |
$364.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$850.50
|
| Rate for Payer: GEHA Commercial |
$756.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$850.50
|
| Rate for Payer: Humana ChoiceCare |
$245.70
|
| Rate for Payer: Multiplan All |
$859.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$567.00
|
| Rate for Payer: OMNI Networks Commercial |
$661.50
|
| Rate for Payer: One Health Plan PPO/POS |
$850.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$897.75
|
| Rate for Payer: Three Rivers Provider Network All |
$708.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$831.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$236.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$878.85
|
| Rate for Payer: Zelis Auto |
$378.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$472.50
|
| Rate for Payer: Zelis Worker's Compensation |
$257.99
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
IP
|
$1,059.00
|
|
|
Service Code
|
CPT 42972
|
| Hospital Charge Code |
6142972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.11 |
| Max. Negotiated Rate |
$1,006.05 |
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$900.15
|
| Rate for Payer: First Health Commercial |
$953.10
|
| Rate for Payer: First Health Workers Compensation |
$408.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$953.10
|
| Rate for Payer: GEHA Commercial |
$741.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$953.10
|
| Rate for Payer: Multiplan All |
$963.69
|
| Rate for Payer: OMNI Networks Commercial |
$741.30
|
| Rate for Payer: One Health Plan PPO/POS |
$953.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,006.05
|
| Rate for Payer: Three Rivers Provider Network All |
$794.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$984.87
|
| Rate for Payer: Zelis Auto |
$423.60
|
| Rate for Payer: Zelis Worker's Compensation |
$289.11
|
|
|
CONTROL NOSE/THROAT BLEEDING
|
Facility
|
OP
|
$1,059.00
|
|
|
Service Code
|
CPT 42972
|
| Hospital Charge Code |
6142972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.11 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$900.15
|
| Rate for Payer: First Health Commercial |
$953.10
|
| Rate for Payer: First Health Workers Compensation |
$408.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$953.10
|
| Rate for Payer: GEHA Commercial |
$847.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$953.10
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$963.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$741.30
|
| Rate for Payer: One Health Plan PPO/POS |
$953.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,006.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$794.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$984.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$423.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$289.11
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6130905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$91.18 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$200.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$283.90
|
| Rate for Payer: First Health Commercial |
$300.60
|
| Rate for Payer: First Health Workers Compensation |
$128.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$300.60
|
| Rate for Payer: GEHA Commercial |
$267.20
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$300.60
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$303.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$233.80
|
| Rate for Payer: One Health Plan PPO/POS |
$300.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$317.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$250.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$310.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$133.60
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$91.18
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6130905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$91.18 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$283.90
|
| Rate for Payer: First Health Commercial |
$300.60
|
| Rate for Payer: First Health Workers Compensation |
$128.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$300.60
|
| Rate for Payer: GEHA Commercial |
$233.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$300.60
|
| Rate for Payer: Multiplan All |
$303.94
|
| Rate for Payer: OMNI Networks Commercial |
$233.80
|
| Rate for Payer: One Health Plan PPO/POS |
$300.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$317.30
|
| Rate for Payer: Three Rivers Provider Network All |
$250.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$310.62
|
| Rate for Payer: Zelis Auto |
$133.60
|
| Rate for Payer: Zelis Worker's Compensation |
$91.18
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
6142960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
8142960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$874.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$552.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna Commercial |
$782.85
|
| Rate for Payer: First Health Commercial |
$828.90
|
| Rate for Payer: First Health Workers Compensation |
$355.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.90
|
| Rate for Payer: GEHA Commercial |
$736.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.90
|
| Rate for Payer: Humana ChoiceCare |
$239.46
|
| Rate for Payer: Multiplan All |
$838.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$552.60
|
| Rate for Payer: OMNI Networks Commercial |
$644.70
|
| Rate for Payer: One Health Plan PPO/POS |
$828.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.95
|
| Rate for Payer: Three Rivers Provider Network All |
$690.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$810.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$230.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$856.53
|
| Rate for Payer: Zelis Auto |
$368.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$460.50
|
| Rate for Payer: Zelis Worker's Compensation |
$251.43
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
8300050
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
8300050
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
8142960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.43 |
| Max. Negotiated Rate |
$874.95 |
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna Commercial |
$782.85
|
| Rate for Payer: First Health Commercial |
$828.90
|
| Rate for Payer: First Health Workers Compensation |
$355.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$828.90
|
| Rate for Payer: GEHA Commercial |
$644.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$828.90
|
| Rate for Payer: Multiplan All |
$838.11
|
| Rate for Payer: OMNI Networks Commercial |
$644.70
|
| Rate for Payer: One Health Plan PPO/POS |
$828.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$874.95
|
| Rate for Payer: Three Rivers Provider Network All |
$690.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$856.53
|
| Rate for Payer: Zelis Auto |
$368.40
|
| Rate for Payer: Zelis Worker's Compensation |
$251.43
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
6142960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
CONTROL THROAT BLEEDING
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 42961
|
| Hospital Charge Code |
6142961
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$611.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
CONTROL THROAT BLEEDING
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
6142962
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.38 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cigna Commercial |
$910.35
|
| Rate for Payer: First Health Commercial |
$963.90
|
| Rate for Payer: First Health Workers Compensation |
$413.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.90
|
| Rate for Payer: GEHA Commercial |
$749.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.90
|
| Rate for Payer: Multiplan All |
$974.61
|
| Rate for Payer: OMNI Networks Commercial |
$749.70
|
| Rate for Payer: One Health Plan PPO/POS |
$963.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,017.45
|
| Rate for Payer: Three Rivers Provider Network All |
$803.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.03
|
| Rate for Payer: Zelis Auto |
$428.40
|
| Rate for Payer: Zelis Worker's Compensation |
$292.38
|
|
|
CONTROL THROAT BLEEDING
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT 42961
|
| Hospital Charge Code |
6142961
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.50 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$524.40
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: First Health Workers Compensation |
$337.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$786.60
|
| Rate for Payer: GEHA Commercial |
$699.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$786.60
|
| Rate for Payer: Humana ChoiceCare |
$227.24
|
| Rate for Payer: Multiplan All |
$795.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$524.40
|
| Rate for Payer: OMNI Networks Commercial |
$611.80
|
| Rate for Payer: One Health Plan PPO/POS |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$830.30
|
| Rate for Payer: Three Rivers Provider Network All |
$655.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$769.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$218.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$812.82
|
| Rate for Payer: Zelis Auto |
$349.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$437.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.60
|
|
|
CONTROL THROAT BLEEDING
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
6142962
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.38 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$642.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cigna Commercial |
$910.35
|
| Rate for Payer: First Health Commercial |
$963.90
|
| Rate for Payer: First Health Workers Compensation |
$413.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$963.90
|
| Rate for Payer: GEHA Commercial |
$856.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$963.90
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$974.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$749.70
|
| Rate for Payer: One Health Plan PPO/POS |
$963.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,017.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$803.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$428.40
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$292.38
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$1,001.34
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
6157461
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.37 |
| 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 |
$600.80
|
| 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 |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cigna Commercial |
$851.14
|
| Rate for Payer: First Health Commercial |
$901.21
|
| Rate for Payer: First Health Workers Compensation |
$386.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.21
|
| Rate for Payer: GEHA Commercial |
$801.07
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.21
|
| 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 |
$911.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$700.94
|
| Rate for Payer: One Health Plan PPO/POS |
$901.21
|
| 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 |
$951.27
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$751.00
|
| 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 |
$931.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$400.54
|
| 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 |
$273.37
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$1,001.34
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
6157461
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.37 |
| Max. Negotiated Rate |
$951.27 |
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cigna Commercial |
$851.14
|
| Rate for Payer: First Health Commercial |
$901.21
|
| Rate for Payer: First Health Workers Compensation |
$386.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.21
|
| Rate for Payer: GEHA Commercial |
$700.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.21
|
| Rate for Payer: Multiplan All |
$911.22
|
| Rate for Payer: OMNI Networks Commercial |
$700.94
|
| Rate for Payer: One Health Plan PPO/POS |
$901.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$951.27
|
| Rate for Payer: Three Rivers Provider Network All |
$751.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$931.25
|
| Rate for Payer: Zelis Auto |
$400.54
|
| Rate for Payer: Zelis Worker's Compensation |
$273.37
|
|
|
copper 24hr urine REF003343
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2299860
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
copper 24hr urine REF003343
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2299860
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$12.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$13.65
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.41
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.10
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.82
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.16
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.41
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$10.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.89
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
