|
DUODENOTOMY EXPLORATION/BX/FB REMOVAL
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
CPT 44010
|
| Hospital Charge Code |
6144010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.86 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cigna Commercial |
$1,537.65
|
| Rate for Payer: First Health Commercial |
$1,628.10
|
| Rate for Payer: First Health Workers Compensation |
$698.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,628.10
|
| Rate for Payer: GEHA Commercial |
$1,266.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,628.10
|
| Rate for Payer: Multiplan All |
$1,646.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,266.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,628.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,718.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,356.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,682.37
|
| Rate for Payer: Zelis Auto |
$723.60
|
| Rate for Payer: Zelis Worker's Compensation |
$493.86
|
|
|
DUODENOTOMY EXPLORATION/BX/FB REMOVAL
|
Facility
|
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 44010
|
| Hospital Charge Code |
21600473
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$686.50 |
| Max. Negotiated Rate |
$2,608.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,647.60
|
| Rate for Payer: Cash Price |
$1,647.60
|
| Rate for Payer: Cigna Commercial |
$2,334.10
|
| Rate for Payer: First Health Commercial |
$2,471.40
|
| Rate for Payer: First Health Workers Compensation |
$1,060.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,471.40
|
| Rate for Payer: GEHA Commercial |
$2,196.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,471.40
|
| Rate for Payer: Humana ChoiceCare |
$713.96
|
| Rate for Payer: Multiplan All |
$2,498.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,647.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,922.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,471.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,608.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,059.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,416.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$686.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,553.78
|
| Rate for Payer: Zelis Auto |
$1,098.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,373.00
|
| Rate for Payer: Zelis Worker's Compensation |
$749.66
|
|
|
DUODENOTOMY EXPLORATION/BX/FB REMOVAL
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
CPT 44010
|
| Hospital Charge Code |
6144010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.25 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,085.40
|
| Rate for Payer: Cash Price |
$1,085.40
|
| Rate for Payer: Cigna Commercial |
$1,537.65
|
| Rate for Payer: First Health Commercial |
$1,628.10
|
| Rate for Payer: First Health Workers Compensation |
$698.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,628.10
|
| Rate for Payer: GEHA Commercial |
$1,447.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,628.10
|
| Rate for Payer: Humana ChoiceCare |
$470.34
|
| Rate for Payer: Multiplan All |
$1,646.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,085.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,266.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,628.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,718.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,356.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,591.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$452.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,682.37
|
| Rate for Payer: Zelis Auto |
$723.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$904.50
|
| Rate for Payer: Zelis Worker's Compensation |
$493.86
|
|
|
DUODENOTOMY EXPLORATION/BX/FB REMOVAL
|
Facility
|
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 44010
|
| Hospital Charge Code |
21600473
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$749.66 |
| Max. Negotiated Rate |
$2,608.70 |
| Rate for Payer: Cash Price |
$1,647.60
|
| Rate for Payer: Cigna Commercial |
$2,334.10
|
| Rate for Payer: First Health Commercial |
$2,471.40
|
| Rate for Payer: First Health Workers Compensation |
$1,060.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,471.40
|
| Rate for Payer: GEHA Commercial |
$1,922.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,471.40
|
| Rate for Payer: Multiplan All |
$2,498.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,922.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,471.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,608.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,059.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,553.78
|
| Rate for Payer: Zelis Auto |
$1,098.40
|
| Rate for Payer: Zelis Worker's Compensation |
$749.66
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STU
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
2400068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,689.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,066.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$1,511.30
|
| Rate for Payer: First Health Commercial |
$1,600.20
|
| Rate for Payer: First Health Workers Compensation |
$686.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,600.20
|
| Rate for Payer: GEHA Commercial |
$1,422.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,600.20
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,617.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,244.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,600.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,689.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,333.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,511.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,653.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$711.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$485.39
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STU
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
2400068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$485.39 |
| Max. Negotiated Rate |
$1,689.10 |
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$1,511.30
|
| Rate for Payer: First Health Commercial |
$1,600.20
|
| Rate for Payer: First Health Workers Compensation |
$686.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,600.20
|
| Rate for Payer: GEHA Commercial |
$1,244.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,600.20
|
| Rate for Payer: Multiplan All |
$1,617.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,244.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,600.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,689.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,333.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,653.54
|
| Rate for Payer: Zelis Auto |
$711.20
|
| Rate for Payer: Zelis Worker's Compensation |
$485.39
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STU
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
2400070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STU
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
2400070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$928.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$986.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
DURAMORPH 0.5MG/ML - 10ML INJ
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT J2274
|
| Hospital Charge Code |
3301295
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$13.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$127.80
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$106.50
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
DURAMORPH 0.5MG/ML - 10ML INJ
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT J2274
|
| Hospital Charge Code |
3301295
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$181.05
|
| Rate for Payer: First Health Commercial |
$191.70
|
| Rate for Payer: First Health Workers Compensation |
$82.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$191.70
|
| Rate for Payer: GEHA Commercial |
$149.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$191.70
|
| Rate for Payer: Multiplan All |
$193.83
|
| Rate for Payer: OMNI Networks Commercial |
$149.10
|
| Rate for Payer: One Health Plan PPO/POS |
$191.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$202.35
|
| Rate for Payer: Three Rivers Provider Network All |
$159.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$198.09
|
| Rate for Payer: Zelis Auto |
$85.20
|
| Rate for Payer: Zelis Worker's Compensation |
$58.15
|
|
|
DURAMORPH 10 MG/10 ML INJ
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3300615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: First Health Commercial |
$82.80
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.80
|
| Rate for Payer: GEHA Commercial |
$64.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.80
|
| Rate for Payer: Multiplan All |
$83.72
|
| Rate for Payer: OMNI Networks Commercial |
$64.40
|
| Rate for Payer: One Health Plan PPO/POS |
$82.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.40
|
| Rate for Payer: Three Rivers Provider Network All |
$69.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.56
|
| Rate for Payer: Zelis Auto |
$36.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
DURAMORPH 10 MG/10 ML INJ
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
3300615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: First Health Commercial |
$82.80
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.80
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.80
|
| Rate for Payer: Humana ChoiceCare |
$23.92
|
| Rate for Payer: Multiplan All |
$83.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$55.20
|
| Rate for Payer: OMNI Networks Commercial |
$64.40
|
| Rate for Payer: One Health Plan PPO/POS |
$82.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.40
|
| Rate for Payer: Three Rivers Provider Network All |
$69.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$80.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.56
|
| Rate for Payer: Zelis Auto |
$36.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
DUTASTERIDE CAP 0.5MG
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
NDC 00173071215
|
| Hospital Charge Code |
3300288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Humana ChoiceCare |
$9.62
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.20
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
DUTASTERIDE CAP 0.5MG
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
NDC 00173071215
|
| Hospital Charge Code |
3300288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$25.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
DXA FOREARM
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
2477081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.02 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$45.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$304.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$323.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.02
|
|
|
DXA FOREARM
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
2477081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.02 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$45.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.02
|
|
|
DXA HIP/SPINE
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
2460079
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$108.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$456.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$108.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$86.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$646.00
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: First Health Workers Compensation |
$99.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.00
|
| Rate for Payer: GEHA Commercial |
$608.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$87.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$691.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$532.00
|
| Rate for Payer: One Health Plan PPO/POS |
$684.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$101.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$87.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$570.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$646.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$87.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$706.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$304.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$70.59
|
|
|
DXA HIP/SPINE
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
2460079
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$646.00
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: First Health Workers Compensation |
$99.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.00
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.00
|
| Rate for Payer: Multiplan All |
$691.60
|
| Rate for Payer: OMNI Networks Commercial |
$532.00
|
| Rate for Payer: One Health Plan PPO/POS |
$684.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.00
|
| Rate for Payer: Three Rivers Provider Network All |
$570.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$706.80
|
| Rate for Payer: Zelis Auto |
$304.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.59
|
|
|
DXA Trabecular Bone Score (TBS), HIP/SPI
|
Facility
|
IP
|
$259.74
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
2477091
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Cash Price |
$155.84
|
| Rate for Payer: Cash Price |
$155.84
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$233.77
|
| Rate for Payer: First Health Workers Compensation |
$34.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.77
|
| Rate for Payer: GEHA Commercial |
$181.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.77
|
| Rate for Payer: Multiplan All |
$236.36
|
| Rate for Payer: OMNI Networks Commercial |
$181.82
|
| Rate for Payer: One Health Plan PPO/POS |
$233.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.75
|
| Rate for Payer: Three Rivers Provider Network All |
$194.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.56
|
| Rate for Payer: Zelis Auto |
$103.90
|
| Rate for Payer: Zelis Worker's Compensation |
$24.07
|
|
|
DXA Trabecular Bone Score (TBS), HIP/SPI
|
Facility
|
OP
|
$259.74
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
2477091
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$123.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$123.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$98.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$155.84
|
| Rate for Payer: Cash Price |
$155.84
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$233.77
|
| Rate for Payer: First Health Workers Compensation |
$34.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.77
|
| Rate for Payer: GEHA Commercial |
$207.79
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.77
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$100.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$236.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$181.82
|
| Rate for Payer: One Health Plan PPO/POS |
$233.77
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$115.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$100.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$194.81
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$220.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$100.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$103.90
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.07
|
|
|
DX BRONCHOSCOPE/BRUSH
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
6131623
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: First Health Workers Compensation |
$176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$410.40
|
| Rate for Payer: GEHA Commercial |
$364.80
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$410.40
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$414.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$319.20
|
| Rate for Payer: One Health Plan PPO/POS |
$410.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$433.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$342.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$182.40
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$124.49
|
|
|
DX BRONCHOSCOPE/BRUSH
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
6131623
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$433.20 |
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: First Health Workers Compensation |
$176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$410.40
|
| Rate for Payer: GEHA Commercial |
$319.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$410.40
|
| Rate for Payer: Multiplan All |
$414.96
|
| Rate for Payer: OMNI Networks Commercial |
$319.20
|
| Rate for Payer: One Health Plan PPO/POS |
$410.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$433.20
|
| Rate for Payer: Three Rivers Provider Network All |
$342.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$424.08
|
| Rate for Payer: Zelis Auto |
$182.40
|
| Rate for Payer: Zelis Worker's Compensation |
$124.49
|
|
|
DX BRONCHOSCOPE/LAVAGE
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
6131624
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$3,274.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,048.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$830.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,637.45
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$368.00
|
| Rate for Payer: GEHA Medicare |
$1,637.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Humana ChoiceCare |
$1,801.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,637.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,750.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$847.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,637.45
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,783.66
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$978.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$847.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,637.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,604.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$847.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,637.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,637.45
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Medicare |
$1,391.83
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,964.94
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
DX BRONCHOSCOPE/LAVAGE
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
6131624
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: First Health Commercial |
$414.00
|
| Rate for Payer: First Health Workers Compensation |
$177.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.00
|
| Rate for Payer: GEHA Commercial |
$322.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.00
|
| Rate for Payer: Multiplan All |
$418.60
|
| Rate for Payer: OMNI Networks Commercial |
$322.00
|
| Rate for Payer: One Health Plan PPO/POS |
$414.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.00
|
| Rate for Payer: Three Rivers Provider Network All |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$427.80
|
| Rate for Payer: Zelis Auto |
$184.00
|
| Rate for Payer: Zelis Worker's Compensation |
$125.58
|
|
|
DX BRONCHOSCOPE/WASH
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
6131622
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$382.50
|
| Rate for Payer: First Health Commercial |
$405.00
|
| Rate for Payer: First Health Workers Compensation |
$173.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$405.00
|
| Rate for Payer: GEHA Commercial |
$315.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$405.00
|
| Rate for Payer: Multiplan All |
$409.50
|
| Rate for Payer: OMNI Networks Commercial |
$315.00
|
| Rate for Payer: One Health Plan PPO/POS |
$405.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$427.50
|
| Rate for Payer: Three Rivers Provider Network All |
$337.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$418.50
|
| Rate for Payer: Zelis Auto |
$180.00
|
| Rate for Payer: Zelis Worker's Compensation |
$122.85
|
|
