|
EPOETIN ALFA INJ 3000 UNITS/ML
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$40.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Worker's Compensation |
$28.39
|
|
|
EPOETIN ALFA INJ 40000 UNIT/ML
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$69.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$98.60
|
| Rate for Payer: First Health Commercial |
$104.40
|
| Rate for Payer: First Health Workers Compensation |
$44.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$104.40
|
| Rate for Payer: GEHA Commercial |
$9.39
|
| Rate for Payer: GEHA Medicare |
$8.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$104.40
|
| Rate for Payer: Humana ChoiceCare |
$9.39
|
| Rate for Payer: Humana Medicare Advantage |
$8.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.54
|
| Rate for Payer: Multiplan All |
$105.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.52
|
| Rate for Payer: OMNI Networks Commercial |
$81.20
|
| Rate for Payer: One Health Plan PPO/POS |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$110.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.08
|
| Rate for Payer: Three Rivers Provider Network All |
$87.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$107.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.54
|
| Rate for Payer: Zelis Auto |
$46.40
|
| Rate for Payer: Zelis Medicare |
$7.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.25
|
| Rate for Payer: Zelis Worker's Compensation |
$31.67
|
|
|
EPOETIN ALFA INJ 40000 UNIT/ML
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3300304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$98.60
|
| Rate for Payer: First Health Commercial |
$104.40
|
| Rate for Payer: First Health Workers Compensation |
$44.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$104.40
|
| Rate for Payer: GEHA Commercial |
$81.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$104.40
|
| Rate for Payer: Multiplan All |
$105.56
|
| Rate for Payer: OMNI Networks Commercial |
$81.20
|
| Rate for Payer: One Health Plan PPO/POS |
$104.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$110.20
|
| Rate for Payer: Three Rivers Provider Network All |
$87.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$107.88
|
| Rate for Payer: Zelis Auto |
$46.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.67
|
|
|
EPOGEN 2000 UNITS/ML
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3301117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: First Health Workers Compensation |
$99.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$9.39
|
| Rate for Payer: GEHA Medicare |
$8.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Humana ChoiceCare |
$9.39
|
| Rate for Payer: Humana Medicare Advantage |
$8.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.54
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.52
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.08
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.54
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Medicare |
$7.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.25
|
| Rate for Payer: Zelis Worker's Compensation |
$70.43
|
|
|
EPOGEN 2000 UNITS/ML
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3301117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: First Health Workers Compensation |
$99.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$180.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Worker's Compensation |
$70.43
|
|
|
EPOGEN 4000 UNITS/ML
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3301118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$178.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$9.39
|
| Rate for Payer: GEHA Medicare |
$8.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Humana ChoiceCare |
$9.39
|
| Rate for Payer: Humana Medicare Advantage |
$8.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.54
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.52
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.08
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.54
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Medicare |
$7.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.25
|
| Rate for Payer: Zelis Worker's Compensation |
$126.40
|
|
|
EPOGEN 4000 UNITS/ML
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
3301118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$178.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Worker's Compensation |
$126.40
|
|
|
ERCP DUCT STENT PLACEMENT
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
6143274
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
ERCP DUCT STENT PLACEMENT
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 43274
|
| Hospital Charge Code |
6143274
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$11,304.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,131.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,652.43
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$5,652.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| 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 |
$2,174.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,652.43
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,609.13
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,511.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,174.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,652.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,304.86
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,539.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,174.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,652.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,652.43
|
| Rate for Payer: Zelis Auto |
$396.00
|
| 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 |
$270.27
|
|
|
ERCP EA DUCT/AMPULLA DILATE
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
6143277
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.82 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$391.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$709.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$276.82
|
|
|
ERCP EA DUCT/AMPULLA DILATE
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 43277
|
| Hospital Charge Code |
6143277
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.82 |
| Max. Negotiated Rate |
$7,225.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,131.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,612.55
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$391.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$811.20
|
| Rate for Payer: GEHA Medicare |
$3,612.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| 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 |
$2,174.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,612.55
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,141.34
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,511.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,174.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,612.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,225.10
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,540.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,174.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,612.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,612.55
|
| Rate for Payer: Zelis Auto |
$405.60
|
| 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 |
$276.82
|
|
|
ERCP LESION ABLATE W/DILATE
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
6143278
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$7,225.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$555.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,131.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,612.55
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$740.80
|
| Rate for Payer: GEHA Medicare |
$3,612.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| 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 |
$2,174.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,612.55
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,141.34
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,511.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,174.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,612.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,225.10
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,540.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,174.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,612.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,612.55
|
| Rate for Payer: Zelis Auto |
$370.40
|
| 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 |
$252.80
|
|
|
ERCP LESION ABLATE W/DILATE
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 43278
|
| Hospital Charge Code |
6143278
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$648.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Worker's Compensation |
$252.80
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
6143265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$880.65 |
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$648.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: Zelis Auto |
$370.80
|
| Rate for Payer: Zelis Worker's Compensation |
$253.07
|
|
|
ERCP LITHOTRIPSY CALCULI
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 43265
|
| Hospital Charge Code |
6143265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$11,304.86 |
| 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 |
$556.20
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,652.43
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$787.95
|
| Rate for Payer: First Health Commercial |
$834.30
|
| Rate for Payer: First Health Workers Compensation |
$357.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$834.30
|
| Rate for Payer: GEHA Commercial |
$741.60
|
| Rate for Payer: GEHA Medicare |
$5,652.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$834.30
|
| 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 |
$1,848.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,652.43
|
| Rate for Payer: Multiplan All |
$843.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,609.13
|
| Rate for Payer: OMNI Networks Commercial |
$648.90
|
| Rate for Payer: One Health Plan PPO/POS |
$834.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,133.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,848.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,652.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$880.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,304.86
|
| Rate for Payer: Three Rivers Provider Network All |
$695.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,539.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,848.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,652.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$862.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,652.43
|
| Rate for Payer: Zelis Auto |
$370.80
|
| 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 |
$253.07
|
|
|
ERCP REMOVE DUCT CALCULI
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
6143264
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.18 |
| Max. Negotiated Rate |
$7,225.10 |
| 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 |
$585.00
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,612.55
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$828.75
|
| Rate for Payer: First Health Commercial |
$877.50
|
| Rate for Payer: First Health Workers Compensation |
$376.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$877.50
|
| Rate for Payer: GEHA Commercial |
$780.00
|
| Rate for Payer: GEHA Medicare |
$3,612.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$877.50
|
| 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 |
$1,848.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,612.55
|
| Rate for Payer: Multiplan All |
$887.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,141.34
|
| Rate for Payer: OMNI Networks Commercial |
$682.50
|
| Rate for Payer: One Health Plan PPO/POS |
$877.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,133.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,848.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,612.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$926.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,225.10
|
| Rate for Payer: Three Rivers Provider Network All |
$731.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,540.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,848.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,612.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$906.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,612.55
|
| Rate for Payer: Zelis Auto |
$390.00
|
| 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 |
$266.18
|
|
|
ERCP REMOVE DUCT CALCULI
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 43264
|
| Hospital Charge Code |
6143264
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.18 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$828.75
|
| Rate for Payer: First Health Commercial |
$877.50
|
| Rate for Payer: First Health Workers Compensation |
$376.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$877.50
|
| Rate for Payer: GEHA Commercial |
$682.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$877.50
|
| Rate for Payer: Multiplan All |
$887.25
|
| Rate for Payer: OMNI Networks Commercial |
$682.50
|
| Rate for Payer: One Health Plan PPO/POS |
$877.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$926.25
|
| Rate for Payer: Three Rivers Provider Network All |
$731.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$906.75
|
| Rate for Payer: Zelis Auto |
$390.00
|
| Rate for Payer: Zelis Worker's Compensation |
$266.18
|
|
|
ERCP REMOVE FORGN BODY DUCT
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
6143275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$605.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,131.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| 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 |
$2,174.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,511.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,174.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,174.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$403.60
|
| 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 |
$275.46
|
|
|
ERCP REMOVE FORGN BODY DUCT
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 43275
|
| Hospital Charge Code |
6143275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$706.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Worker's Compensation |
$275.46
|
|
|
ERCP SPHINCTER PRESSURE MEAS
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
6143263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$910.10 |
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$670.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: Zelis Auto |
$383.20
|
| Rate for Payer: Zelis Worker's Compensation |
$261.53
|
|
|
ERCP SPHINCTER PRESSURE MEAS
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 43263
|
| Hospital Charge Code |
6143263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$3,602.54 |
| 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 |
$574.80
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$766.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| 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 |
$1,848.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,133.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,848.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,848.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$383.20
|
| 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 |
$261.53
|
|
|
ERCP STENT EXCHANGE W/DILATE
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
6143276
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.19 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cigna Commercial |
$875.50
|
| Rate for Payer: First Health Commercial |
$927.00
|
| Rate for Payer: First Health Workers Compensation |
$397.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$927.00
|
| Rate for Payer: GEHA Commercial |
$721.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$927.00
|
| Rate for Payer: Multiplan All |
$937.30
|
| Rate for Payer: OMNI Networks Commercial |
$721.00
|
| Rate for Payer: One Health Plan PPO/POS |
$927.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$978.50
|
| Rate for Payer: Three Rivers Provider Network All |
$772.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$957.90
|
| Rate for Payer: Zelis Auto |
$412.00
|
| Rate for Payer: Zelis Worker's Compensation |
$281.19
|
|
|
ERCP STENT EXCHANGE W/DILATE
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 43276
|
| Hospital Charge Code |
6143276
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.19 |
| Max. Negotiated Rate |
$11,304.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$618.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,131.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,652.43
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cigna Commercial |
$875.50
|
| Rate for Payer: First Health Commercial |
$927.00
|
| Rate for Payer: First Health Workers Compensation |
$397.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$927.00
|
| Rate for Payer: GEHA Commercial |
$824.00
|
| Rate for Payer: GEHA Medicare |
$5,652.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$927.00
|
| 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 |
$2,174.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,652.43
|
| Rate for Payer: Multiplan All |
$937.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,609.13
|
| Rate for Payer: OMNI Networks Commercial |
$721.00
|
| Rate for Payer: One Health Plan PPO/POS |
$927.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,511.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,174.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,652.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$978.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,304.86
|
| Rate for Payer: Three Rivers Provider Network All |
$772.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,539.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,174.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,652.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$957.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,652.43
|
| Rate for Payer: Zelis Auto |
$412.00
|
| 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 |
$281.19
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
6143260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$7,225.10 |
| 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 |
$519.00
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,612.55
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$692.00
|
| Rate for Payer: GEHA Medicare |
$3,612.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| 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 |
$1,848.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,612.55
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,141.34
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,133.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,848.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,612.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,225.10
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,540.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,848.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,612.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,612.55
|
| Rate for Payer: Zelis Auto |
$346.00
|
| 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 |
$236.15
|
|
|
ERCP W/SPECIMEN COLLECTION
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 43260
|
| Hospital Charge Code |
6143260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$605.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: Zelis Auto |
$346.00
|
| Rate for Payer: Zelis Worker's Compensation |
$236.15
|
|
