|
ESOPHAGUS ENDOSCOPY
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
6143217
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.60 |
| 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 |
$315.60
|
| 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 |
$315.60
|
| 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 |
$420.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| 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 |
$499.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| 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 |
$489.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$143.60
|
|
|
ESOPHAGUS ENDOSCOPY
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
6143200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$278.35 |
| 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 |
$205.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: OMNI Networks Commercial |
$205.10
|
| Rate for Payer: One Health Plan PPO/POS |
$263.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
ESOPHAGUS ENDOSCOPY
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
6143215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.49 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$396.95
|
| Rate for Payer: First Health Commercial |
$420.30
|
| Rate for Payer: First Health Workers Compensation |
$180.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$420.30
|
| Rate for Payer: GEHA Commercial |
$326.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$420.30
|
| Rate for Payer: Multiplan All |
$424.97
|
| Rate for Payer: OMNI Networks Commercial |
$326.90
|
| Rate for Payer: One Health Plan PPO/POS |
$420.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$443.65
|
| Rate for Payer: Three Rivers Provider Network All |
$350.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$434.31
|
| Rate for Payer: Zelis Auto |
$186.80
|
| Rate for Payer: Zelis Worker's Compensation |
$127.49
|
|
|
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 |
$1,780.50 |
| 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 |
$890.25
|
| 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 |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| 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 |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$278.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$219.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
ESOPHAGUS ENDOSCOPY BIOPSY
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
6143202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$239.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
ESOPHAGUS ENDOSCOPY BIOPSY
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
6143202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$93.37 |
| 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 |
$205.20
|
| 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 |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$273.60
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| 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 |
$311.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| 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 |
$324.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| 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 |
$318.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
ESOPHAGUS ENDOSCOPY/LESION
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
6143216
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$306.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Worker's Compensation |
$119.57
|
|
|
ESOPHAGUS ENDOSCOPY/LESION
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 43216
|
| Hospital Charge Code |
6143216
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.57 |
| 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 |
$262.80
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$169.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$350.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| 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 |
$416.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| 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 |
$407.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$175.20
|
| 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 |
$119.57
|
|
|
ESOPHAGUS ENDOSCOPY/LIGATION
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
6143205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$323.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| Rate for Payer: Multiplan All |
$420.42
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$438.90
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$429.66
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
ESOPHAGUS ENDOSCOPY/LIGATION
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 43205
|
| Hospital Charge Code |
6143205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.13 |
| 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 |
$277.20
|
| 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 |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| 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 |
$420.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| 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 |
$438.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| 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 |
$429.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Facility
|
IP
|
$558.00
|
|
| Hospital Charge Code |
6191010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Facility
|
OP
|
$558.00
|
|
| Hospital Charge Code |
6191010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$145.08
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$334.80
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.00
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
ESOPH ENDOSCOPE W/DRAIN CYST
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
6143240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$588.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.00
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.20
|
| Rate for Payer: Zelis Auto |
$336.00
|
| Rate for Payer: Zelis Worker's Compensation |
$229.32
|
|
|
ESOPH ENDOSCOPE W/DRAIN CYST
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
6143240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$11,304.86 |
| 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 |
$504.00
|
| 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 |
$5,652.43
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: GEHA Medicare |
$5,652.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,652.43
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,609.13
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| 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 |
$5,652.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,304.86
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,539.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,652.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,652.43
|
| Rate for Payer: Zelis Auto |
$336.00
|
| 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 |
$229.32
|
|
|
ESOPH ENDOSCOPY DILATION
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
6143249
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$343.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| Rate for Payer: Multiplan All |
$445.90
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$465.50
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$455.70
|
| Rate for Payer: Zelis Auto |
$196.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.77
|
|
|
ESOPH ENDOSCOPY DILATION
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
6143220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$261.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Worker's Compensation |
$102.10
|
|
|
ESOPH ENDOSCOPY DILATION
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
6143249
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.77 |
| 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 |
$294.00
|
| 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 |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$392.00
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| 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 |
$445.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| 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 |
$465.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| 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 |
$455.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$196.00
|
| 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 |
$133.77
|
|
|
ESOPH ENDOSCOPY DILATION
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
6143226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.39 |
| 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 |
$258.00
|
| 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 |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$344.00
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| 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 |
$391.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| 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 |
$408.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| 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 |
$399.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$172.00
|
| 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 |
$117.39
|
|
|
ESOPH ENDOSCOPY DILATION
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 43226
|
| Hospital Charge Code |
6143226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$301.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
ESOPH ENDOSCOPY DILATION
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
6143220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$102.10 |
| 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 |
$224.40
|
| 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 |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$299.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| 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 |
$340.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| 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 |
$355.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| 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 |
$347.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$149.60
|
| 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 |
$102.10
|
|
|
ESOPH ENDOSCOPY REPAIR
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
6143227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: First Health Workers Compensation |
$203.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$501.60
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: Zelis Auto |
$211.20
|
| Rate for Payer: Zelis Worker's Compensation |
$144.14
|
|
|
ESOPH ENDOSCOPY REPAIR
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
6143227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$144.14 |
| 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 |
$316.80
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$448.80
|
| Rate for Payer: First Health Commercial |
$475.20
|
| Rate for Payer: First Health Workers Compensation |
$203.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$475.20
|
| Rate for Payer: GEHA Commercial |
$422.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$475.20
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$480.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$369.60
|
| Rate for Payer: One Health Plan PPO/POS |
$475.20
|
| 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 |
$501.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$396.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$491.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$211.20
|
| 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 |
$144.14
|
|
|
ESOPH ENDOSCOPY W/US EXAM
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
6143231
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.78 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$444.55
|
| Rate for Payer: First Health Commercial |
$470.70
|
| Rate for Payer: First Health Workers Compensation |
$201.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$470.70
|
| Rate for Payer: GEHA Commercial |
$366.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$470.70
|
| Rate for Payer: Multiplan All |
$475.93
|
| Rate for Payer: OMNI Networks Commercial |
$366.10
|
| Rate for Payer: One Health Plan PPO/POS |
$470.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$496.85
|
| Rate for Payer: Three Rivers Provider Network All |
$392.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$486.39
|
| Rate for Payer: Zelis Auto |
$209.20
|
| Rate for Payer: Zelis Worker's Compensation |
$142.78
|
|
|
ESOPH ENDOSCOPY W/US EXAM
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 43231
|
| Hospital Charge Code |
6143231
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.78 |
| 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 |
$313.80
|
| 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 |
$1,801.27
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$444.55
|
| Rate for Payer: First Health Commercial |
$470.70
|
| Rate for Payer: First Health Workers Compensation |
$201.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$470.70
|
| Rate for Payer: GEHA Commercial |
$418.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$470.70
|
| 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 |
$475.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$366.10
|
| Rate for Payer: One Health Plan PPO/POS |
$470.70
|
| 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 |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$496.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$392.25
|
| 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 |
$486.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$209.20
|
| 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 |
$142.78
|
|
|
ESOPH ENDOSCOPY W/US FN BX
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 43232
|
| Hospital Charge Code |
6143232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
