|
ESMOLOL 100MG/10ML VIAL (IV PUSH ONLY)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
NDC 63323065210
|
| Hospital Charge Code |
3301047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
ESMOLOL 100MG/10ML VIAL (IV PUSH ONLY)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
NDC 63323065210
|
| Hospital Charge Code |
3301047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
ESMOLOL IN SWFI IVPB 2500MG/250ML
|
Facility
|
OP
|
$933.00
|
|
|
Service Code
|
NDC 44567081110
|
| Hospital Charge Code |
3301078
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$233.25 |
| Max. Negotiated Rate |
$886.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$746.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| Rate for Payer: Humana ChoiceCare |
$242.58
|
| Rate for Payer: Multiplan All |
$849.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$559.80
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$821.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$867.69
|
| Rate for Payer: Zelis Auto |
$373.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$466.50
|
| Rate for Payer: Zelis Worker's Compensation |
$254.71
|
|
|
ESMOLOL IN SWFI IVPB 2500MG/250ML
|
Facility
|
IP
|
$933.00
|
|
|
Service Code
|
NDC 44567081110
|
| Hospital Charge Code |
3301078
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$254.71 |
| Max. Negotiated Rate |
$886.35 |
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$793.05
|
| Rate for Payer: First Health Commercial |
$839.70
|
| Rate for Payer: First Health Workers Compensation |
$360.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$839.70
|
| Rate for Payer: GEHA Commercial |
$653.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$839.70
|
| Rate for Payer: Multiplan All |
$849.03
|
| Rate for Payer: OMNI Networks Commercial |
$653.10
|
| Rate for Payer: One Health Plan PPO/POS |
$839.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$886.35
|
| Rate for Payer: Three Rivers Provider Network All |
$699.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$867.69
|
| Rate for Payer: Zelis Auto |
$373.20
|
| Rate for Payer: Zelis Worker's Compensation |
$254.71
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,816.96
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$1,816.96 |
| 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 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 |
$908.48
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| 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 |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$1,816.96
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$1,816.96 |
| 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 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 |
$908.48
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| 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 |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$1,816.96
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$1,816.96 |
| 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 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 |
$908.48
|
| Rate for Payer: First Health Workers Compensation |
$1,169.21
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| 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 |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
| Rate for Payer: Zelis Worker's Compensation |
$826.72
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE
|
Facility
|
OP
|
$3,676.30
|
|
|
Service Code
|
CPT 43246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$3,676.30 |
| 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 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 |
$1,838.15
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| 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 |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$1,816.96
|
|
|
Service Code
|
CPT 43247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$1,816.96 |
| 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 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 |
$908.48
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| 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 |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$3,676.30
|
|
|
Service Code
|
CPT 43251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$3,676.30 |
| 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 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 |
$1,838.15
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| 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 |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$3,676.30
|
|
|
Service Code
|
CPT 43249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$700.56 |
| Max. Negotiated Rate |
$3,676.30 |
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| 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 |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| 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 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 |
$1,838.15
|
|
|
ESOPHAGOMYOTOMY ABDOMINAL
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
CPT 43330
|
| Hospital Charge Code |
6143330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$764.40 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cigna Commercial |
$2,380.00
|
| Rate for Payer: First Health Commercial |
$2,520.00
|
| Rate for Payer: First Health Workers Compensation |
$1,081.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,520.00
|
| Rate for Payer: GEHA Commercial |
$1,960.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,520.00
|
| Rate for Payer: Multiplan All |
$2,548.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,960.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,520.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,660.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,100.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,604.00
|
| Rate for Payer: Zelis Auto |
$1,120.00
|
| Rate for Payer: Zelis Worker's Compensation |
$764.40
|
|
|
ESOPHAGOMYOTOMY ABDOMINAL
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
CPT 43330
|
| Hospital Charge Code |
6143330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cigna Commercial |
$2,380.00
|
| Rate for Payer: First Health Commercial |
$2,520.00
|
| Rate for Payer: First Health Workers Compensation |
$1,081.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,520.00
|
| Rate for Payer: GEHA Commercial |
$2,240.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,520.00
|
| Rate for Payer: Humana ChoiceCare |
$728.00
|
| Rate for Payer: Multiplan All |
$2,548.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,680.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,960.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,520.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,660.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,100.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,464.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$700.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,604.00
|
| Rate for Payer: Zelis Auto |
$1,120.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,400.00
|
| Rate for Payer: Zelis Worker's Compensation |
$764.40
|
|
|
ESOPHAGOMYOTOMY THORACIC
|
Facility
|
OP
|
$2,844.00
|
|
|
Service Code
|
CPT 43331
|
| Hospital Charge Code |
6143331
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$2,701.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,706.40
|
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Cigna Commercial |
$2,417.40
|
| Rate for Payer: First Health Commercial |
$2,559.60
|
| Rate for Payer: First Health Workers Compensation |
$1,098.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,559.60
|
| Rate for Payer: GEHA Commercial |
$2,275.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,559.60
|
| Rate for Payer: Humana ChoiceCare |
$739.44
|
| Rate for Payer: Multiplan All |
$2,588.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,706.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,990.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,559.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,701.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,133.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,502.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$711.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,644.92
|
| Rate for Payer: Zelis Auto |
$1,137.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,422.00
|
| Rate for Payer: Zelis Worker's Compensation |
$776.41
|
|
|
ESOPHAGOMYOTOMY THORACIC
|
Facility
|
IP
|
$2,844.00
|
|
|
Service Code
|
CPT 43331
|
| Hospital Charge Code |
6143331
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$776.41 |
| Max. Negotiated Rate |
$2,701.80 |
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: Cigna Commercial |
$2,417.40
|
| Rate for Payer: First Health Commercial |
$2,559.60
|
| Rate for Payer: First Health Workers Compensation |
$1,098.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,559.60
|
| Rate for Payer: GEHA Commercial |
$1,990.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,559.60
|
| Rate for Payer: Multiplan All |
$2,588.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,990.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,559.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,701.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,133.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,644.92
|
| Rate for Payer: Zelis Auto |
$1,137.60
|
| Rate for Payer: Zelis Worker's Compensation |
$776.41
|
|
|
ESOPHAGOPLASTY CONGENITAL
|
Facility
|
OP
|
$5,653.00
|
|
|
Service Code
|
CPT 43313
|
| Hospital Charge Code |
6143313
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,413.25 |
| Max. Negotiated Rate |
$5,370.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,391.80
|
| Rate for Payer: Cash Price |
$3,391.80
|
| Rate for Payer: Cigna Commercial |
$4,805.05
|
| Rate for Payer: First Health Commercial |
$5,087.70
|
| Rate for Payer: First Health Workers Compensation |
$2,182.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,087.70
|
| Rate for Payer: GEHA Commercial |
$4,522.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,087.70
|
| Rate for Payer: Humana ChoiceCare |
$1,469.78
|
| Rate for Payer: Multiplan All |
$5,144.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,391.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,957.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,087.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,370.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,239.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,974.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,413.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,257.29
|
| Rate for Payer: Zelis Auto |
$2,261.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,826.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,543.27
|
|
|
ESOPHAGOPLASTY CONGENITAL
|
Facility
|
IP
|
$5,653.00
|
|
|
Service Code
|
CPT 43313
|
| Hospital Charge Code |
6143313
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,543.27 |
| Max. Negotiated Rate |
$5,370.35 |
| Rate for Payer: Cash Price |
$3,391.80
|
| Rate for Payer: Cigna Commercial |
$4,805.05
|
| Rate for Payer: First Health Commercial |
$5,087.70
|
| Rate for Payer: First Health Workers Compensation |
$2,182.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,087.70
|
| Rate for Payer: GEHA Commercial |
$3,957.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,087.70
|
| Rate for Payer: Multiplan All |
$5,144.23
|
| Rate for Payer: OMNI Networks Commercial |
$3,957.10
|
| Rate for Payer: One Health Plan PPO/POS |
$5,087.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,370.35
|
| Rate for Payer: Three Rivers Provider Network All |
$4,239.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,257.29
|
| Rate for Payer: Zelis Auto |
$2,261.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,543.27
|
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
6143229
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$7,373.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,739.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$378.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,739.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,169.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,686.51
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna Commercial |
$535.50
|
| Rate for Payer: First Health Commercial |
$567.00
|
| Rate for Payer: First Health Workers Compensation |
$243.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$567.00
|
| Rate for Payer: GEHA Commercial |
$504.00
|
| Rate for Payer: GEHA Medicare |
$3,686.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$567.00
|
| Rate for Payer: Humana ChoiceCare |
$4,055.16
|
| Rate for Payer: Humana Medicare Advantage |
$3,686.51
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,193.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,214.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,686.51
|
| Rate for Payer: Multiplan All |
$573.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,267.07
|
| Rate for Payer: OMNI Networks Commercial |
$441.00
|
| Rate for Payer: One Health Plan PPO/POS |
$567.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,556.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,214.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,686.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,373.02
|
| Rate for Payer: Three Rivers Provider Network All |
$472.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,612.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,214.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$585.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,686.51
|
| Rate for Payer: Zelis Auto |
$252.00
|
| Rate for Payer: Zelis Medicare |
$3,133.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,423.81
|
| Rate for Payer: Zelis Worker's Compensation |
$171.99
|
|
|
ESOPHAGOSCOPY LESION ABLATE
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
6143229
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna Commercial |
$535.50
|
| Rate for Payer: First Health Commercial |
$567.00
|
| Rate for Payer: First Health Workers Compensation |
$243.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$567.00
|
| Rate for Payer: GEHA Commercial |
$441.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$567.00
|
| Rate for Payer: Multiplan All |
$573.30
|
| Rate for Payer: OMNI Networks Commercial |
$441.00
|
| Rate for Payer: One Health Plan PPO/POS |
$567.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$598.50
|
| Rate for Payer: Three Rivers Provider Network All |
$472.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$585.90
|
| Rate for Payer: Zelis Auto |
$252.00
|
| Rate for Payer: Zelis Worker's Compensation |
$171.99
|
|
|
ESOPHAGOSCOPY RIGID TRANSORAL/W FB REM
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 43194
|
| Hospital Charge Code |
6143192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.53 |
| Max. Negotiated Rate |
$579.50 |
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$518.50
|
| Rate for Payer: First Health Commercial |
$549.00
|
| Rate for Payer: First Health Workers Compensation |
$235.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.00
|
| Rate for Payer: GEHA Commercial |
$427.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.00
|
| Rate for Payer: Multiplan All |
$555.10
|
| Rate for Payer: OMNI Networks Commercial |
$427.00
|
| Rate for Payer: One Health Plan PPO/POS |
$549.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$579.50
|
| Rate for Payer: Three Rivers Provider Network All |
$457.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$567.30
|
| Rate for Payer: Zelis Auto |
$244.00
|
| Rate for Payer: Zelis Worker's Compensation |
$166.53
|
|
|
ESOPHAGOSCOPY RIGID TRANSORAL/W FB REM
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 43194
|
| Hospital Charge Code |
6143192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.53 |
| Max. Negotiated Rate |
$3,676.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,409.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,409.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,116.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,838.15
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$518.50
|
| Rate for Payer: First Health Commercial |
$549.00
|
| Rate for Payer: First Health Workers Compensation |
$235.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$549.00
|
| Rate for Payer: GEHA Commercial |
$488.00
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$549.00
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,139.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: Multiplan All |
$555.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| Rate for Payer: OMNI Networks Commercial |
$427.00
|
| Rate for Payer: One Health Plan PPO/POS |
$549.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,315.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,139.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$579.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: Three Rivers Provider Network All |
$457.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,139.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$567.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Auto |
$244.00
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
| Rate for Payer: Zelis Worker's Compensation |
$166.53
|
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
6143191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$456.95 |
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$336.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| Rate for Payer: Multiplan All |
$437.71
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$447.33
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Worker's Compensation |
$131.31
|
|
|
ESOPHAGOSCOPY RIGID TRNSO DX
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
CPT 43191
|
| Hospital Charge Code |
6143191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$3,676.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$932.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$288.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$932.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$738.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,838.15
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$384.80
|
| Rate for Payer: GEHA Medicare |
$1,838.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| Rate for Payer: Humana ChoiceCare |
$2,021.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,838.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,088.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$754.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,838.15
|
| Rate for Payer: Multiplan All |
$437.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,124.86
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$870.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$754.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,838.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,676.30
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$754.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,838.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$447.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,838.15
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Medicare |
$1,562.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,205.78
|
| Rate for Payer: Zelis Worker's Compensation |
$131.31
|
|
|
ESOPHAGUS ENDOSCOPY
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
6143217
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$447.10
|
| Rate for Payer: First Health Commercial |
$473.40
|
| Rate for Payer: First Health Workers Compensation |
$203.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$473.40
|
| Rate for Payer: GEHA Commercial |
$368.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$499.70
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$489.18
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Worker's Compensation |
$143.60
|
|
|
ESOPHAGUS ENDOSCOPY
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
6143200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$1,816.96 |
| 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 |
$175.80
|
| 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 |
$908.48
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$249.05
|
| Rate for Payer: First Health Commercial |
$263.70
|
| Rate for Payer: First Health Workers Compensation |
$113.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$263.70
|
| Rate for Payer: GEHA Commercial |
$234.40
|
| Rate for Payer: GEHA Medicare |
$908.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Humana ChoiceCare |
$999.33
|
| Rate for Payer: Humana Medicare Advantage |
$908.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,526.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$908.48
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.42
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| 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 |
$908.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,816.96
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$890.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$908.48
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Medicare |
$772.21
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.18
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
