|
DILATE ESOPHAGUS
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
6143453
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
|
DILATE ESOPHAGUS
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
6143453
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$3,676.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$602.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$602.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$477.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,838.15
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$231.20
|
| Rate for Payer: First Health Commercial |
$244.80
|
| Rate for Payer: First Health Workers Compensation |
$105.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$244.80
|
| Rate for Payer: GEHA Commercial |
$217.60
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$244.80
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$487.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: Multiplan All |
$247.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| Rate for Payer: OMNI Networks Commercial |
$190.40
|
| Rate for Payer: One Health Plan PPO/POS |
$244.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$562.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$487.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$258.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: Three Rivers Provider Network All |
$204.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$252.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Auto |
$108.80
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
| Rate for Payer: Zelis Worker's Compensation |
$74.26
|
|
|
DILATE ESOPHAGUS
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
8543456
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$222.22 |
| Max. Negotiated Rate |
$773.30 |
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cigna Commercial |
$691.90
|
| Rate for Payer: First Health Commercial |
$732.60
|
| Rate for Payer: First Health Workers Compensation |
$314.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$732.60
|
| Rate for Payer: GEHA Commercial |
$569.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$732.60
|
| Rate for Payer: Multiplan All |
$740.74
|
| Rate for Payer: OMNI Networks Commercial |
$569.80
|
| Rate for Payer: One Health Plan PPO/POS |
$732.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$773.30
|
| Rate for Payer: Three Rivers Provider Network All |
$610.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.02
|
| Rate for Payer: Zelis Auto |
$325.60
|
| Rate for Payer: Zelis Worker's Compensation |
$222.22
|
|
|
DILATE ESOPHAGUS
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
8543456
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$222.22 |
| Max. Negotiated Rate |
$3,676.30 |
| Rate for Payer: Cigna Commercial |
$691.90
|
| Rate for Payer: First Health Commercial |
$732.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,409.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$488.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,409.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,116.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,838.15
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: First Health Workers Compensation |
$314.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$732.60
|
| Rate for Payer: GEHA Commercial |
$651.20
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$732.60
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,139.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: Multiplan All |
$740.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| Rate for Payer: OMNI Networks Commercial |
$569.80
|
| Rate for Payer: One Health Plan PPO/POS |
$732.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,315.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,139.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$773.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: Three Rivers Provider Network All |
$610.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,139.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Auto |
$325.60
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
| Rate for Payer: Zelis Worker's Compensation |
$222.22
|
|
|
DILATE ESOPHAGUS
|
Facility
|
IP
|
$4,156.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
21643213
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$1,134.59 |
| Max. Negotiated Rate |
$3,948.20 |
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cigna Commercial |
$3,532.60
|
| Rate for Payer: First Health Commercial |
$3,740.40
|
| Rate for Payer: First Health Workers Compensation |
$1,604.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,740.40
|
| Rate for Payer: GEHA Commercial |
$2,909.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,740.40
|
| Rate for Payer: Multiplan All |
$3,781.96
|
| Rate for Payer: OMNI Networks Commercial |
$2,909.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,740.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,948.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,117.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,865.08
|
| Rate for Payer: Zelis Auto |
$1,662.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,134.59
|
|
|
DILATE ESOPHAGUS
|
Facility
|
OP
|
$4,156.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
21643213
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$1,116.57 |
| Max. Negotiated Rate |
$3,948.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,409.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,493.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,409.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,116.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,838.15
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cash Price |
$2,493.60
|
| Rate for Payer: Cigna Commercial |
$3,532.60
|
| Rate for Payer: First Health Commercial |
$3,740.40
|
| Rate for Payer: First Health Workers Compensation |
$1,604.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,740.40
|
| Rate for Payer: GEHA Commercial |
$3,324.80
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,740.40
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,139.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: Multiplan All |
$3,781.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,909.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,740.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,315.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,139.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,948.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,117.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,139.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,865.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Auto |
$1,662.40
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
| Rate for Payer: Zelis Worker's Compensation |
$1,134.59
|
|
|
DILAT ESOPH UNGUIDED SOUND/BOUGIE 1/MULT
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
20300070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$1,816.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$602.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$602.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$477.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$908.48
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$393.60
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$487.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$562.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$487.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
DILAT ESOPH UNGUIDED SOUND/BOUGIE 1/MULT
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
6143450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$96.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$175.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$68.52
|
|
|
DILAT ESOPH UNGUIDED SOUND/BOUGIE 1/MULT
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
6143450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$68.52 |
| Max. Negotiated Rate |
$1,816.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$602.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$602.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$477.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$908.48
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$213.35
|
| Rate for Payer: First Health Commercial |
$225.90
|
| Rate for Payer: First Health Workers Compensation |
$96.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.90
|
| Rate for Payer: GEHA Commercial |
$200.80
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.90
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$487.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: Multiplan All |
$228.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| Rate for Payer: OMNI Networks Commercial |
$175.70
|
| Rate for Payer: One Health Plan PPO/POS |
$225.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$562.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$487.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$238.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: Three Rivers Provider Network All |
$188.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$233.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Auto |
$100.40
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
| Rate for Payer: Zelis Worker's Compensation |
$68.52
|
|
|
DILAT ESOPH UNGUIDED SOUND/BOUGIE 1/MULT
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
20300070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
DILATE URETHRA STRICTURE
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 53621
|
| Hospital Charge Code |
6153621
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$471.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$134.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$235.67
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: First Health Commercial |
$201.60
|
| Rate for Payer: First Health Workers Compensation |
$86.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$201.60
|
| Rate for Payer: GEHA Commercial |
$179.20
|
| Rate for Payer: GEHA Medicare |
$235.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Humana ChoiceCare |
$259.24
|
| Rate for Payer: Humana Medicare Advantage |
$235.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$395.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$235.67
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$400.64
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$235.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$471.34
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$230.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$235.67
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Medicare |
$200.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$282.80
|
| Rate for Payer: Zelis Worker's Compensation |
$61.15
|
|
|
DILATE URETHRA STRICTURE
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 53605
|
| Hospital Charge Code |
6153605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$6,683.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,364.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,341.98
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$77.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$161.60
|
| Rate for Payer: GEHA Medicare |
$3,341.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Humana ChoiceCare |
$3,676.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,341.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,614.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,341.98
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,681.37
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,607.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,341.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,683.96
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,275.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,341.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,341.98
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Medicare |
$2,840.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,010.38
|
| Rate for Payer: Zelis Worker's Compensation |
$55.15
|
|
|
DILATE URETHRA STRICTURE
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 53605
|
| Hospital Charge Code |
6153605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$171.70
|
| Rate for Payer: First Health Commercial |
$181.80
|
| Rate for Payer: First Health Workers Compensation |
$77.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$181.80
|
| Rate for Payer: GEHA Commercial |
$141.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$181.80
|
| Rate for Payer: Multiplan All |
$183.82
|
| Rate for Payer: OMNI Networks Commercial |
$141.40
|
| Rate for Payer: One Health Plan PPO/POS |
$181.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$191.90
|
| Rate for Payer: Three Rivers Provider Network All |
$151.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$187.86
|
| Rate for Payer: Zelis Auto |
$80.80
|
| Rate for Payer: Zelis Worker's Compensation |
$55.15
|
|
|
DILATE URETHRA STRICTURE
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 53621
|
| Hospital Charge Code |
6153621
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: First Health Commercial |
$201.60
|
| Rate for Payer: First Health Workers Compensation |
$86.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$201.60
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$201.60
|
| Rate for Payer: Multiplan All |
$203.84
|
| Rate for Payer: OMNI Networks Commercial |
$156.80
|
| Rate for Payer: One Health Plan PPO/POS |
$201.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$212.80
|
| Rate for Payer: Three Rivers Provider Network All |
$168.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$208.32
|
| Rate for Payer: Zelis Auto |
$89.60
|
| Rate for Payer: Zelis Worker's Compensation |
$61.15
|
|
|
DILAT FEM URETHRA W/SUPPOSIT&/INSTLJ INI
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
6153660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$303.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$151.61
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
DILAT FEM URETHRA W/SUPPOSIT&/INSTLJ INI
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
8900017
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
DILAT FEM URETHRA W/SUPPOSIT&/INSTLJ INI
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
6153660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
DILAT FEM URETHRA W/SUPPOSIT&/INSTLJ INI
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
8900017
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$303.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$151.61
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
DILAT FEM URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
9200010
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$79.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$164.00
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$55.97
|
|
|
DILAT FEM URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
6153661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$124.90
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$79.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$164.00
|
| Rate for Payer: GEHA Medicare |
$124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Humana ChoiceCare |
$137.39
|
| Rate for Payer: Humana Medicare Advantage |
$124.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$209.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$124.90
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$212.33
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$249.80
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$124.90
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Medicare |
$106.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$149.88
|
| Rate for Payer: Zelis Worker's Compensation |
$55.97
|
|
|
DILAT FEM URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
6153661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$79.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$143.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$55.97
|
|
|
DILAT FEM URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
9200010
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$79.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$143.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$55.97
|
|
|
DILATION AND CURETTAGE
|
Facility
|
OP
|
$835.14
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
6158120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.99 |
| Max. Negotiated Rate |
$6,161.80 |
| 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 |
$501.08
|
| 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 |
$3,080.90
|
| Rate for Payer: Cash Price |
$501.08
|
| Rate for Payer: Cash Price |
$501.08
|
| Rate for Payer: Cigna Commercial |
$709.87
|
| Rate for Payer: First Health Commercial |
$751.63
|
| Rate for Payer: First Health Workers Compensation |
$322.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.63
|
| Rate for Payer: GEHA Commercial |
$668.11
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.63
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: Multiplan All |
$759.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| Rate for Payer: OMNI Networks Commercial |
$584.60
|
| Rate for Payer: One Health Plan PPO/POS |
$751.63
|
| 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 |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$793.38
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: Three Rivers Provider Network All |
$626.36
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$776.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Auto |
$334.06
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$227.99
|
|
|
DILATION AND CURETTAGE
|
Facility
|
IP
|
$835.14
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
6158120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.99 |
| Max. Negotiated Rate |
$793.38 |
| Rate for Payer: Cash Price |
$501.08
|
| Rate for Payer: Cigna Commercial |
$709.87
|
| Rate for Payer: First Health Commercial |
$751.63
|
| Rate for Payer: First Health Workers Compensation |
$322.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.63
|
| Rate for Payer: GEHA Commercial |
$584.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.63
|
| Rate for Payer: Multiplan All |
$759.98
|
| Rate for Payer: OMNI Networks Commercial |
$584.60
|
| Rate for Payer: One Health Plan PPO/POS |
$751.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$793.38
|
| Rate for Payer: Three Rivers Provider Network All |
$626.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$776.68
|
| Rate for Payer: Zelis Auto |
$334.06
|
| Rate for Payer: Zelis Worker's Compensation |
$227.99
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$6,161.80
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,605.60 |
| Max. Negotiated Rate |
$6,161.80 |
| 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 |
$3,080.90
|
| Rate for Payer: First Health Workers Compensation |
$3,965.12
|
| Rate for Payer: GEHA Medicare |
$3,080.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.99
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.53
|
| 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 |
$3,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.90
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.08
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.62
|
|
