|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
23500056
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$161.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$215.20
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
OP
|
$281.13
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
8558100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.75 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$168.68
|
| Rate for Payer: Cash Price |
$168.68
|
| Rate for Payer: Cigna Commercial |
$238.96
|
| Rate for Payer: First Health Commercial |
$253.02
|
| Rate for Payer: First Health Workers Compensation |
$108.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.02
|
| Rate for Payer: GEHA Commercial |
$224.90
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.02
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$255.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$196.79
|
| Rate for Payer: One Health Plan PPO/POS |
$253.02
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$210.85
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$112.45
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$76.75
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
OP
|
$281.13
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
7258100
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.75 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$168.68
|
| Rate for Payer: Cash Price |
$168.68
|
| Rate for Payer: Cigna Commercial |
$238.96
|
| Rate for Payer: First Health Commercial |
$253.02
|
| Rate for Payer: First Health Workers Compensation |
$108.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.02
|
| Rate for Payer: GEHA Commercial |
$224.90
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.02
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$255.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$196.79
|
| Rate for Payer: One Health Plan PPO/POS |
$253.02
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$210.85
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$112.45
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$76.75
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
IP
|
$281.13
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
7258100
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.75 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: Cash Price |
$168.68
|
| Rate for Payer: Cigna Commercial |
$238.96
|
| Rate for Payer: First Health Commercial |
$253.02
|
| Rate for Payer: First Health Workers Compensation |
$108.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.02
|
| Rate for Payer: GEHA Commercial |
$196.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.02
|
| Rate for Payer: Multiplan All |
$255.83
|
| Rate for Payer: OMNI Networks Commercial |
$196.79
|
| Rate for Payer: One Health Plan PPO/POS |
$253.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.07
|
| Rate for Payer: Three Rivers Provider Network All |
$210.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.45
|
| Rate for Payer: Zelis Auto |
$112.45
|
| Rate for Payer: Zelis Worker's Compensation |
$76.75
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
IP
|
$281.13
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
8558100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.75 |
| Max. Negotiated Rate |
$267.07 |
| Rate for Payer: Cash Price |
$168.68
|
| Rate for Payer: Cigna Commercial |
$238.96
|
| Rate for Payer: First Health Commercial |
$253.02
|
| Rate for Payer: First Health Workers Compensation |
$108.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.02
|
| Rate for Payer: GEHA Commercial |
$196.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.02
|
| Rate for Payer: Multiplan All |
$255.83
|
| Rate for Payer: OMNI Networks Commercial |
$196.79
|
| Rate for Payer: One Health Plan PPO/POS |
$253.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.07
|
| Rate for Payer: Three Rivers Provider Network All |
$210.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.45
|
| Rate for Payer: Zelis Auto |
$112.45
|
| Rate for Payer: Zelis Worker's Compensation |
$76.75
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
6158100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$161.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$215.20
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
23500056
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$188.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DI
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
6158100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$228.65
|
| Rate for Payer: First Health Commercial |
$242.10
|
| Rate for Payer: First Health Workers Compensation |
$103.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$242.10
|
| Rate for Payer: GEHA Commercial |
$188.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$242.10
|
| Rate for Payer: Multiplan All |
$244.79
|
| Rate for Payer: OMNI Networks Commercial |
$188.30
|
| Rate for Payer: One Health Plan PPO/POS |
$242.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$255.55
|
| Rate for Payer: Three Rivers Provider Network All |
$201.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$250.17
|
| Rate for Payer: Zelis Auto |
$107.60
|
| Rate for Payer: Zelis Worker's Compensation |
$73.44
|
|
|
ENDOMETRIAL CRYOABLATION
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
CPT 58356
|
| Hospital Charge Code |
6158356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.02 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$646.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$915.45
|
| Rate for Payer: First Health Commercial |
$969.30
|
| Rate for Payer: First Health Workers Compensation |
$415.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$969.30
|
| Rate for Payer: GEHA Commercial |
$861.60
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$969.30
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$980.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$753.90
|
| Rate for Payer: One Health Plan PPO/POS |
$969.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,023.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$807.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,001.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$430.80
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$294.02
|
|
|
ENDOMETRIAL CRYOABLATION
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
CPT 58356
|
| Hospital Charge Code |
6158356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.02 |
| Max. Negotiated Rate |
$1,023.15 |
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$915.45
|
| Rate for Payer: First Health Commercial |
$969.30
|
| Rate for Payer: First Health Workers Compensation |
$415.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$969.30
|
| Rate for Payer: GEHA Commercial |
$753.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$969.30
|
| Rate for Payer: Multiplan All |
$980.07
|
| Rate for Payer: OMNI Networks Commercial |
$753.90
|
| Rate for Payer: One Health Plan PPO/POS |
$969.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,023.15
|
| Rate for Payer: Three Rivers Provider Network All |
$807.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,001.61
|
| Rate for Payer: Zelis Auto |
$430.80
|
| Rate for Payer: Zelis Worker's Compensation |
$294.02
|
|
|
endomysial ab iga REF164996
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
22990744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
endomysial ab iga REF164996
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
22990744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
ENDOSCOPIC INJECTION/IMPLANT
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
6151715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$414.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
ENDOSCOPIC INJECTION/IMPLANT
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
6151715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cigna Commercial |
$440.30
|
| Rate for Payer: First Health Commercial |
$466.20
|
| Rate for Payer: First Health Workers Compensation |
$200.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$466.20
|
| Rate for Payer: GEHA Commercial |
$362.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$466.20
|
| Rate for Payer: Multiplan All |
$471.38
|
| Rate for Payer: OMNI Networks Commercial |
$362.60
|
| Rate for Payer: One Health Plan PPO/POS |
$466.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$492.10
|
| Rate for Payer: Three Rivers Provider Network All |
$388.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$481.74
|
| Rate for Payer: Zelis Auto |
$207.20
|
| Rate for Payer: Zelis Worker's Compensation |
$141.41
|
|
|
ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 43273
|
| Hospital Charge Code |
6143273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$2,286.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,286.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,286.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,811.11
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: First Health Workers Compensation |
$146.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.00
|
| Rate for Payer: GEHA Commercial |
$304.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.00
|
| Rate for Payer: Humana ChoiceCare |
$98.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,848.00
|
| Rate for Payer: Multiplan All |
$345.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$228.00
|
| Rate for Payer: OMNI Networks Commercial |
$266.00
|
| Rate for Payer: One Health Plan PPO/POS |
$342.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,133.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,848.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.00
|
| Rate for Payer: Three Rivers Provider Network All |
$285.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,848.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$353.40
|
| Rate for Payer: Zelis Auto |
$152.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$103.74
|
|
|
ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 43273
|
| Hospital Charge Code |
6143273
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$103.74 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: First Health Workers Compensation |
$146.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.00
|
| Rate for Payer: GEHA Commercial |
$266.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.00
|
| Rate for Payer: Multiplan All |
$345.80
|
| Rate for Payer: OMNI Networks Commercial |
$266.00
|
| Rate for Payer: One Health Plan PPO/POS |
$342.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.00
|
| Rate for Payer: Three Rivers Provider Network All |
$285.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$353.40
|
| Rate for Payer: Zelis Auto |
$152.00
|
| Rate for Payer: Zelis Worker's Compensation |
$103.74
|
|
|
ENDOSCOPIC PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29893
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ENDOSCOPIC US EXAM ESOPH
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 43237
|
| Hospital Charge Code |
6143237
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.69 |
| 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 |
$318.00
|
| 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 |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$450.50
|
| Rate for Payer: First Health Commercial |
$477.00
|
| Rate for Payer: First Health Workers Compensation |
$204.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$477.00
|
| Rate for Payer: GEHA Commercial |
$424.00
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$477.00
|
| 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 |
$482.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$371.00
|
| Rate for Payer: One Health Plan PPO/POS |
$477.00
|
| 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 |
$503.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$397.50
|
| 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 |
$492.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$212.00
|
| 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 |
$144.69
|
|
|
ENDOSCOPIC US EXAM ESOPH
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 43237
|
| Hospital Charge Code |
6143237
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.69 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$450.50
|
| Rate for Payer: First Health Commercial |
$477.00
|
| Rate for Payer: First Health Workers Compensation |
$204.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$477.00
|
| Rate for Payer: GEHA Commercial |
$371.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$477.00
|
| Rate for Payer: Multiplan All |
$482.30
|
| Rate for Payer: OMNI Networks Commercial |
$371.00
|
| Rate for Payer: One Health Plan PPO/POS |
$477.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$503.50
|
| Rate for Payer: Three Rivers Provider Network All |
$397.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$492.90
|
| Rate for Payer: Zelis Auto |
$212.00
|
| Rate for Payer: Zelis Worker's Compensation |
$144.69
|
|
|
ENDOSCOPY BOWEL POUCH/BIOP
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
6144386
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
ENDOSCOPY BOWEL POUCH/BIOP
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
6144386
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$80.81 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$177.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$251.60
|
| Rate for Payer: First Health Commercial |
$266.40
|
| Rate for Payer: First Health Workers Compensation |
$114.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$266.40
|
| Rate for Payer: GEHA Commercial |
$236.80
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$266.40
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$269.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$207.20
|
| Rate for Payer: One Health Plan PPO/POS |
$266.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$281.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$222.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$275.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$118.40
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$80.81
|
|
|
ENDOSCOPY MAXILLARY SINUS
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
CPT 31267
|
| Hospital Charge Code |
6131267
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$781.85 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$576.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
ENDOSCOPY MAXILLARY SINUS
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
CPT 31267
|
| Hospital Charge Code |
6131267
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$699.55
|
| Rate for Payer: First Health Commercial |
$740.70
|
| Rate for Payer: First Health Workers Compensation |
$317.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$740.70
|
| Rate for Payer: GEHA Commercial |
$658.40
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$740.70
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$748.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$576.10
|
| Rate for Payer: One Health Plan PPO/POS |
$740.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$781.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$617.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$765.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$329.20
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$224.68
|
|
|
ENDOSCOPY OF BOWEL POUCH
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
6144385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$920.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$729.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$744.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$859.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$744.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$744.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
ENDOSCOPY OF BOWEL POUCH
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
6144385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
