|
ED VISIT STRAIGHTFORWARD MDM
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8199282
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$109.65
|
| Rate for Payer: First Health Commercial |
$116.10
|
| Rate for Payer: First Health Workers Compensation |
$49.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$116.10
|
| Rate for Payer: GEHA Commercial |
$90.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$116.10
|
| Rate for Payer: Multiplan All |
$117.39
|
| Rate for Payer: OMNI Networks Commercial |
$90.30
|
| Rate for Payer: One Health Plan PPO/POS |
$116.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$122.55
|
| Rate for Payer: Three Rivers Provider Network All |
$96.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.97
|
| Rate for Payer: Zelis Auto |
$51.60
|
| Rate for Payer: Zelis Worker's Compensation |
$35.22
|
|
|
ED VISIT STRAIGHTFORWARD MDM
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
8199282
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$300.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$150.37
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$109.65
|
| Rate for Payer: First Health Commercial |
$116.10
|
| Rate for Payer: First Health Workers Compensation |
$49.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$116.10
|
| Rate for Payer: GEHA Commercial |
$103.20
|
| Rate for Payer: GEHA Medicare |
$150.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$116.10
|
| Rate for Payer: Humana ChoiceCare |
$165.41
|
| Rate for Payer: Humana Medicare Advantage |
$150.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$252.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$150.37
|
| Rate for Payer: Multiplan All |
$117.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$255.63
|
| Rate for Payer: OMNI Networks Commercial |
$90.30
|
| Rate for Payer: One Health Plan PPO/POS |
$116.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$150.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$122.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$300.74
|
| Rate for Payer: Three Rivers Provider Network All |
$96.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$147.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$150.37
|
| Rate for Payer: Zelis Auto |
$51.60
|
| Rate for Payer: Zelis Medicare |
$127.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$180.44
|
| Rate for Payer: Zelis Worker's Compensation |
$35.22
|
|
|
ED VST THAT MAY NOT REQ PRSNCE OF PROVID
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
14099281
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.99
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$169.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$15.39
|
| Rate for Payer: First Health Workers Compensation |
$20.48
|
| Rate for Payer: GEHA Commercial |
$10.99
|
| Rate for Payer: GEHA Medicare |
$10.99
|
| Rate for Payer: Health Net Federal Services Government |
$10.99
|
| Rate for Payer: HealthSmart Commercial |
$15.39
|
| Rate for Payer: HealthSmart Worker's Compensation |
$19.66
|
| Rate for Payer: Humana ChoiceCare |
$12.09
|
| Rate for Payer: Humana Medicare Advantage |
$10.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.99
|
| Rate for Payer: Multiplan All |
$212.25
|
| Rate for Payer: National Preferred Provider Network Commercial |
$268.85
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$20.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.54
|
| Rate for Payer: OMNI Networks Commercial |
$198.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$22.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$22.04
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.85
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.99
|
| Rate for Payer: Zelis Medicare |
$9.34
|
| Rate for Payer: Zelis Worker's Compensation |
$14.48
|
|
|
ED VST THAT MAY NOT REQ PRSNCE OF PROVID
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8199281
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
ED VST THAT MAY NOT REQ PRSNCE OF PROVID
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
8199281
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$167.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$63.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$25.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$52.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| 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 |
$64.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$74.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$64.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$18.02
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
6143255
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: First Health Commercial |
$576.00
|
| Rate for Payer: First Health Workers Compensation |
$247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.00
|
| Rate for Payer: GEHA Commercial |
$512.00
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
EGD CONTROL BLEEDING ANY
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
6143255
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$544.00
|
| Rate for Payer: First Health Commercial |
$576.00
|
| Rate for Payer: First Health Workers Compensation |
$247.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.00
|
| Rate for Payer: GEHA Commercial |
$448.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.00
|
| Rate for Payer: Multiplan All |
$582.40
|
| Rate for Payer: OMNI Networks Commercial |
$448.00
|
| Rate for Payer: One Health Plan PPO/POS |
$576.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.00
|
| Rate for Payer: Three Rivers Provider Network All |
$480.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$595.20
|
| Rate for Payer: Zelis Auto |
$256.00
|
| Rate for Payer: Zelis Worker's Compensation |
$174.72
|
|
|
EGD ENDO MUCOSAL RESECTION
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
6143254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$619.65
|
| Rate for Payer: First Health Commercial |
$656.10
|
| Rate for Payer: First Health Workers Compensation |
$281.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$656.10
|
| Rate for Payer: GEHA Commercial |
$510.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$656.10
|
| Rate for Payer: Multiplan All |
$663.39
|
| Rate for Payer: OMNI Networks Commercial |
$510.30
|
| Rate for Payer: One Health Plan PPO/POS |
$656.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$692.55
|
| Rate for Payer: Three Rivers Provider Network All |
$546.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.97
|
| Rate for Payer: Zelis Auto |
$291.60
|
| Rate for Payer: Zelis Worker's Compensation |
$199.02
|
|
|
EGD ENDO MUCOSAL RESECTION
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 43254
|
| Hospital Charge Code |
6143254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$932.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$932.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$738.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$619.65
|
| Rate for Payer: First Health Commercial |
$656.10
|
| Rate for Payer: First Health Workers Compensation |
$281.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$656.10
|
| Rate for Payer: GEHA Commercial |
$583.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$656.10
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$754.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$663.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$510.30
|
| Rate for Payer: One Health Plan PPO/POS |
$656.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$870.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$754.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$692.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$546.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$754.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$291.60
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$199.02
|
|
|
EGD ENDOSCOPIC STENT PLACE
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
6143266
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$11,304.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,299.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$367.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,299.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,652.43
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$489.60
|
| Rate for Payer: GEHA Medicare |
$5,652.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| Rate for Payer: Humana ChoiceCare |
$6,217.67
|
| Rate for Payer: Humana Medicare Advantage |
$5,652.43
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,496.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,666.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,652.43
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,609.13
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,079.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,666.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,652.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$581.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,304.86
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,539.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,666.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,652.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,652.43
|
| Rate for Payer: Zelis Auto |
$244.80
|
| Rate for Payer: Zelis Medicare |
$4,804.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,782.92
|
| Rate for Payer: Zelis Worker's Compensation |
$167.08
|
|
|
EGD ENDOSCOPIC STENT PLACE
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
6143266
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$428.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$581.40
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: Zelis Auto |
$244.80
|
| Rate for Payer: Zelis Worker's Compensation |
$167.08
|
|
|
EGD LESION ABLATION
|
Facility
|
OP
|
$717.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
6143270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$195.74 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$430.20
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna Commercial |
$609.45
|
| Rate for Payer: First Health Commercial |
$645.30
|
| Rate for Payer: First Health Workers Compensation |
$276.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$645.30
|
| Rate for Payer: GEHA Commercial |
$573.60
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$645.30
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,139.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$652.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$501.90
|
| Rate for Payer: One Health Plan PPO/POS |
$645.30
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$681.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$537.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,139.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$666.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$286.80
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$195.74
|
|
|
EGD LESION ABLATION
|
Facility
|
IP
|
$717.00
|
|
|
Service Code
|
CPT 43270
|
| Hospital Charge Code |
6143270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$195.74 |
| Max. Negotiated Rate |
$681.15 |
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna Commercial |
$609.45
|
| Rate for Payer: First Health Commercial |
$645.30
|
| Rate for Payer: First Health Workers Compensation |
$276.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$645.30
|
| Rate for Payer: GEHA Commercial |
$501.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$645.30
|
| Rate for Payer: Multiplan All |
$652.47
|
| Rate for Payer: OMNI Networks Commercial |
$501.90
|
| Rate for Payer: One Health Plan PPO/POS |
$645.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$681.15
|
| Rate for Payer: Three Rivers Provider Network All |
$537.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$666.81
|
| Rate for Payer: Zelis Auto |
$286.80
|
| Rate for Payer: Zelis Worker's Compensation |
$195.74
|
|
|
EGD US EXAM DUODENUM/JEJUNUM
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
6143259
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.53 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$518.50
|
| Rate for Payer: First Health Commercial |
$549.00
|
| Rate for Payer: First Health Workers Compensation |
$235.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.00
|
| Rate for Payer: GEHA Commercial |
$488.00
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.00
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$555.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$427.00
|
| Rate for Payer: One Health Plan PPO/POS |
$549.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$579.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$457.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$567.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$244.00
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$166.53
|
|
|
EGD US EXAM DUODENUM/JEJUNUM
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
6143259
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.53 |
| Max. Negotiated Rate |
$579.50 |
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$518.50
|
| Rate for Payer: First Health Commercial |
$549.00
|
| Rate for Payer: First Health Workers Compensation |
$235.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.00
|
| Rate for Payer: GEHA Commercial |
$427.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.00
|
| Rate for Payer: Multiplan All |
$555.10
|
| Rate for Payer: OMNI Networks Commercial |
$427.00
|
| Rate for Payer: One Health Plan PPO/POS |
$549.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$579.50
|
| Rate for Payer: Three Rivers Provider Network All |
$457.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$567.30
|
| Rate for Payer: Zelis Auto |
$244.00
|
| Rate for Payer: Zelis Worker's Compensation |
$166.53
|
|
|
EGD US TRANSMURAL INJXN/MARK
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
6143253
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$192.74 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$600.10
|
| Rate for Payer: First Health Commercial |
$635.40
|
| Rate for Payer: First Health Workers Compensation |
$272.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$635.40
|
| Rate for Payer: GEHA Commercial |
$494.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$635.40
|
| Rate for Payer: Multiplan All |
$642.46
|
| Rate for Payer: OMNI Networks Commercial |
$494.20
|
| Rate for Payer: One Health Plan PPO/POS |
$635.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$670.70
|
| Rate for Payer: Three Rivers Provider Network All |
$529.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$656.58
|
| Rate for Payer: Zelis Auto |
$282.40
|
| Rate for Payer: Zelis Worker's Compensation |
$192.74
|
|
|
EGD US TRANSMURAL INJXN/MARK
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 43253
|
| Hospital Charge Code |
6143253
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$192.74 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$423.60
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$600.10
|
| Rate for Payer: First Health Commercial |
$635.40
|
| Rate for Payer: First Health Workers Compensation |
$272.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$635.40
|
| Rate for Payer: GEHA Commercial |
$564.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$635.40
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,139.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$642.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$494.20
|
| Rate for Payer: One Health Plan PPO/POS |
$635.40
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$670.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$529.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,139.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$656.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$282.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$192.74
|
|
|
EGD W/THRML TXMNT GERD
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
6143257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.44 |
| Max. Negotiated Rate |
$7,225.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,453.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$376.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,453.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,944.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,612.55
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$533.80
|
| Rate for Payer: First Health Commercial |
$565.20
|
| Rate for Payer: First Health Workers Compensation |
$242.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$565.20
|
| Rate for Payer: GEHA Commercial |
$502.40
|
| Rate for Payer: GEHA Medicare |
$3,612.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$565.20
|
| Rate for Payer: Humana ChoiceCare |
$3,973.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,612.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,069.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,983.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,612.55
|
| Rate for Payer: Multiplan All |
$571.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,141.34
|
| Rate for Payer: OMNI Networks Commercial |
$439.60
|
| Rate for Payer: One Health Plan PPO/POS |
$565.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,290.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,983.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,612.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$596.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,225.10
|
| Rate for Payer: Three Rivers Provider Network All |
$471.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,540.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,983.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,612.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,612.55
|
| Rate for Payer: Zelis Auto |
$251.20
|
| Rate for Payer: Zelis Medicare |
$3,070.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,335.06
|
| Rate for Payer: Zelis Worker's Compensation |
$171.44
|
|
|
EGD W/THRML TXMNT GERD
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
6143257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.44 |
| Max. Negotiated Rate |
$596.60 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$533.80
|
| Rate for Payer: First Health Commercial |
$565.20
|
| Rate for Payer: First Health Workers Compensation |
$242.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$565.20
|
| Rate for Payer: GEHA Commercial |
$439.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$565.20
|
| Rate for Payer: Multiplan All |
$571.48
|
| Rate for Payer: OMNI Networks Commercial |
$439.60
|
| Rate for Payer: One Health Plan PPO/POS |
$565.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$596.60
|
| Rate for Payer: Three Rivers Provider Network All |
$471.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.04
|
| Rate for Payer: Zelis Auto |
$251.20
|
| Rate for Payer: Zelis Worker's Compensation |
$171.44
|
|
|
egg white IgE REF602452
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
egg white IgE REF602452
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
egg yolk IgE REF602487
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200715
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
egg yolk IgE REF602487
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200715
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
EH DOA PRE-EMP IN-HOUSE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT G0481
|
| Hospital Charge Code |
2200150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$352.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$352.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$352.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$279.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$156.59
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: GEHA Medicare |
$156.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$172.25
|
| Rate for Payer: Humana Medicare Advantage |
$156.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$263.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$284.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$156.59
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$266.20
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$328.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$284.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$156.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$313.18
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$153.46
|
| Rate for Payer: United Healthcare Commercial |
$43.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$284.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$156.59
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Medicare |
$133.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$187.91
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
EH DOA PRE-EMP IN-HOUSE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT G0481
|
| Hospital Charge Code |
2200150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
