|
HYLENEX 150 USP/ 1 ML INJ
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT J3473
|
| Hospital Charge Code |
3302627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: First Health Commercial |
$327.60
|
| Rate for Payer: First Health Workers Compensation |
$140.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$327.60
|
| Rate for Payer: GEHA Commercial |
$0.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$327.60
|
| Rate for Payer: Humana ChoiceCare |
$94.64
|
| Rate for Payer: Multiplan All |
$331.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$218.40
|
| Rate for Payer: OMNI Networks Commercial |
$254.80
|
| Rate for Payer: One Health Plan PPO/POS |
$327.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$345.80
|
| Rate for Payer: Three Rivers Provider Network All |
$273.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$320.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$338.52
|
| Rate for Payer: Zelis Auto |
$145.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$182.00
|
| Rate for Payer: Zelis Worker's Compensation |
$99.37
|
|
|
HYMENOTOMY
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
6156442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$55.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$101.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Worker's Compensation |
$39.59
|
|
|
HYMENOTOMY
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
6156442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$87.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$123.25
|
| Rate for Payer: First Health Commercial |
$130.50
|
| Rate for Payer: First Health Workers Compensation |
$55.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$130.50
|
| Rate for Payer: GEHA Commercial |
$116.00
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$130.50
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$131.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$101.50
|
| Rate for Payer: One Health Plan PPO/POS |
$130.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$137.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$108.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$134.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$58.00
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$39.59
|
|
|
HYOID MYOTOMY & SUSPENSION
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
CPT 21685
|
| Hospital Charge Code |
6121685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$563.47 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,238.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cigna Commercial |
$1,754.40
|
| Rate for Payer: First Health Commercial |
$1,857.60
|
| Rate for Payer: First Health Workers Compensation |
$796.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,857.60
|
| Rate for Payer: GEHA Commercial |
$1,651.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,857.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,878.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,444.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,857.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,960.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,548.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,919.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$825.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$563.47
|
|
|
HYOID MYOTOMY & SUSPENSION
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
CPT 21685
|
| Hospital Charge Code |
6121685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$563.47 |
| Max. Negotiated Rate |
$1,960.80 |
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cigna Commercial |
$1,754.40
|
| Rate for Payer: First Health Commercial |
$1,857.60
|
| Rate for Payer: First Health Workers Compensation |
$796.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,857.60
|
| Rate for Payer: GEHA Commercial |
$1,444.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,857.60
|
| Rate for Payer: Multiplan All |
$1,878.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,444.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,857.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,960.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,548.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,919.52
|
| Rate for Payer: Zelis Auto |
$825.60
|
| Rate for Payer: Zelis Worker's Compensation |
$563.47
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TAB
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 62559042101
|
| Hospital Charge Code |
3300434
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TAB
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 62559042101
|
| Hospital Charge Code |
3300434
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
HYOSCYAMINE TAB 0.375MG
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 64543011201
|
| Hospital Charge Code |
3300435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$10.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Humana ChoiceCare |
$3.38
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.80
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
HYOSCYAMINE TAB 0.375MG
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 64543011201
|
| Hospital Charge Code |
3300435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: First Health Commercial |
$11.70
|
| Rate for Payer: First Health Workers Compensation |
$5.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11.70
|
| Rate for Payer: GEHA Commercial |
$9.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11.70
|
| Rate for Payer: Multiplan All |
$11.83
|
| Rate for Payer: OMNI Networks Commercial |
$9.10
|
| Rate for Payer: One Health Plan PPO/POS |
$11.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12.35
|
| Rate for Payer: Three Rivers Provider Network All |
$9.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12.09
|
| Rate for Payer: Zelis Auto |
$5.20
|
| Rate for Payer: Zelis Worker's Compensation |
$3.55
|
|
|
HYPNOTHERAPY
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
9599246
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
HYPNOTHERAPY
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
8499244
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
HYPNOTHERAPY
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
8590880
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: First Health Commercial |
$261.00
|
| Rate for Payer: First Health Workers Compensation |
$111.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.00
|
| Rate for Payer: GEHA Commercial |
$232.00
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.00
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$263.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$203.00
|
| Rate for Payer: One Health Plan PPO/POS |
$261.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$275.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$217.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Commercial |
$246.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$269.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$116.00
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$79.17
|
|
|
HYPNOTHERAPY
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
8499244
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
HYPNOTHERAPY
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
8590880
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$79.17 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: First Health Commercial |
$261.00
|
| Rate for Payer: First Health Workers Compensation |
$111.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.00
|
| Rate for Payer: GEHA Commercial |
$203.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.00
|
| Rate for Payer: Multiplan All |
$263.90
|
| Rate for Payer: OMNI Networks Commercial |
$203.00
|
| Rate for Payer: One Health Plan PPO/POS |
$261.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$275.50
|
| Rate for Payer: Three Rivers Provider Network All |
$217.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$269.70
|
| Rate for Payer: Zelis Auto |
$116.00
|
| Rate for Payer: Zelis Worker's Compensation |
$79.17
|
|
|
HYPNOTHERAPY
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
9599246
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
HYPOGLYCEMIC PANEL
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
22990745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: First Health Commercial |
$198.00
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.00
|
| Rate for Payer: GEHA Commercial |
$154.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.00
|
| Rate for Payer: Multiplan All |
$200.20
|
| Rate for Payer: OMNI Networks Commercial |
$154.00
|
| Rate for Payer: One Health Plan PPO/POS |
$198.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.00
|
| Rate for Payer: Three Rivers Provider Network All |
$165.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$204.60
|
| Rate for Payer: Zelis Auto |
$88.00
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
HYPOGLYCEMIC PANEL
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
22990745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$187.00
|
| Rate for Payer: First Health Commercial |
$198.00
|
| Rate for Payer: First Health Workers Compensation |
$30.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.00
|
| Rate for Payer: GEHA Commercial |
$176.00
|
| Rate for Payer: GEHA Medicare |
$24.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.00
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Humana Medicare Advantage |
$24.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$40.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$24.11
|
| Rate for Payer: Multiplan All |
$200.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$40.99
|
| Rate for Payer: OMNI Networks Commercial |
$154.00
|
| Rate for Payer: One Health Plan PPO/POS |
$198.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$24.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$48.22
|
| Rate for Payer: Three Rivers Provider Network All |
$165.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$23.63
|
| Rate for Payer: United Healthcare Commercial |
$187.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$204.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$24.11
|
| Rate for Payer: Zelis Auto |
$88.00
|
| Rate for Payer: Zelis Medicare |
$20.49
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.93
|
| Rate for Payer: Zelis Worker's Compensation |
$21.89
|
|
|
HYSTERECTOMY/BLADDER REPAIR
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
CPT 51925
|
| Hospital Charge Code |
6151925
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$621.62 |
| Max. Negotiated Rate |
$2,163.15 |
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cigna Commercial |
$1,935.45
|
| Rate for Payer: First Health Commercial |
$2,049.30
|
| Rate for Payer: First Health Workers Compensation |
$879.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,049.30
|
| Rate for Payer: GEHA Commercial |
$1,593.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,049.30
|
| Rate for Payer: Multiplan All |
$2,072.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,593.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,049.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,163.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,707.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,117.61
|
| Rate for Payer: Zelis Auto |
$910.80
|
| Rate for Payer: Zelis Worker's Compensation |
$621.62
|
|
|
HYSTERECTOMY/BLADDER REPAIR
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
CPT 51925
|
| Hospital Charge Code |
6151925
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$569.25 |
| Max. Negotiated Rate |
$2,163.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,366.20
|
| Rate for Payer: Cash Price |
$1,366.20
|
| Rate for Payer: Cigna Commercial |
$1,935.45
|
| Rate for Payer: First Health Commercial |
$2,049.30
|
| Rate for Payer: First Health Workers Compensation |
$879.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,049.30
|
| Rate for Payer: GEHA Commercial |
$1,821.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,049.30
|
| Rate for Payer: Humana ChoiceCare |
$592.02
|
| Rate for Payer: Multiplan All |
$2,072.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,366.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,593.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,049.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,163.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,707.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,003.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$569.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,117.61
|
| Rate for Payer: Zelis Auto |
$910.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,138.50
|
| Rate for Payer: Zelis Worker's Compensation |
$621.62
|
|
|
HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO
|
Facility
|
IP
|
$3,643.23
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
6158558
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$994.60 |
| Max. Negotiated Rate |
$3,461.07 |
| Rate for Payer: Cash Price |
$2,185.94
|
| Rate for Payer: Cigna Commercial |
$3,096.75
|
| Rate for Payer: First Health Commercial |
$3,278.91
|
| Rate for Payer: First Health Workers Compensation |
$1,406.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,278.91
|
| Rate for Payer: GEHA Commercial |
$2,550.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,278.91
|
| Rate for Payer: Multiplan All |
$3,315.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,550.26
|
| Rate for Payer: One Health Plan PPO/POS |
$3,278.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,461.07
|
| Rate for Payer: Three Rivers Provider Network All |
$2,732.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,388.20
|
| Rate for Payer: Zelis Auto |
$1,457.29
|
| Rate for Payer: Zelis Worker's Compensation |
$994.60
|
|
|
HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO
|
Facility
|
OP
|
$3,643.23
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
6158558
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$994.60 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,185.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,809.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$2,185.94
|
| Rate for Payer: Cash Price |
$2,185.94
|
| Rate for Payer: Cigna Commercial |
$3,096.75
|
| Rate for Payer: First Health Commercial |
$3,278.91
|
| Rate for Payer: First Health Workers Compensation |
$1,406.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,278.91
|
| Rate for Payer: GEHA Commercial |
$2,914.58
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,278.91
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,846.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$3,315.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,550.26
|
| Rate for Payer: One Health Plan PPO/POS |
$3,278.91
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,132.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,846.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,461.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,732.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,846.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,388.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$1,457.29
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$994.60
|
|
|
HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO
|
Facility
|
IP
|
$3,983.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
23500055
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,087.36 |
| Max. Negotiated Rate |
$3,783.85 |
| Rate for Payer: Cash Price |
$2,389.80
|
| Rate for Payer: Cigna Commercial |
$3,385.55
|
| Rate for Payer: First Health Commercial |
$3,584.70
|
| Rate for Payer: First Health Workers Compensation |
$1,537.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,584.70
|
| Rate for Payer: GEHA Commercial |
$2,788.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,584.70
|
| Rate for Payer: Multiplan All |
$3,624.53
|
| Rate for Payer: OMNI Networks Commercial |
$2,788.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,584.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,783.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,987.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,704.19
|
| Rate for Payer: Zelis Auto |
$1,593.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,087.36
|
|
|
HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO
|
Facility
|
OP
|
$3,983.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
23500055
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,087.36 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,389.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,809.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$2,389.80
|
| Rate for Payer: Cash Price |
$2,389.80
|
| Rate for Payer: Cigna Commercial |
$3,385.55
|
| Rate for Payer: First Health Commercial |
$3,584.70
|
| Rate for Payer: First Health Workers Compensation |
$1,537.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,584.70
|
| Rate for Payer: GEHA Commercial |
$3,186.40
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,584.70
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,846.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$3,624.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,788.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,584.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,132.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,846.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,783.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,987.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,846.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,704.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$1,593.20
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$1,087.36
|
|
|
HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDU
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
23500054
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$530.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,809.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$707.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,846.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,132.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,846.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,846.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDU
|
Facility
|
OP
|
$148.90
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
6158555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.65 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$89.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,809.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$89.34
|
| Rate for Payer: Cash Price |
$89.34
|
| Rate for Payer: Cigna Commercial |
$126.56
|
| Rate for Payer: First Health Commercial |
$134.01
|
| Rate for Payer: First Health Workers Compensation |
$57.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.01
|
| Rate for Payer: GEHA Commercial |
$119.12
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.01
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,846.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$135.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$104.23
|
| Rate for Payer: One Health Plan PPO/POS |
$134.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,132.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,846.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.46
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$111.67
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,846.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$59.56
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$40.65
|
|
