|
ANOSCOPY REMOVE LESIONS
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 46612
|
| Hospital Charge Code |
6146612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
ANOSCOPY W/BX SINGLE/MULTIPLE
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
6146606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
ANOSCOPY W/BX SINGLE/MULTIPLE
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
20300076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$606.90
|
| Rate for Payer: First Health Commercial |
$642.60
|
| Rate for Payer: First Health Workers Compensation |
$275.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$642.60
|
| Rate for Payer: GEHA Commercial |
$499.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$642.60
|
| Rate for Payer: Multiplan All |
$649.74
|
| Rate for Payer: OMNI Networks Commercial |
$499.80
|
| Rate for Payer: One Health Plan PPO/POS |
$642.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$678.30
|
| Rate for Payer: Three Rivers Provider Network All |
$535.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.02
|
| Rate for Payer: Zelis Auto |
$285.60
|
| Rate for Payer: Zelis Worker's Compensation |
$194.92
|
|
|
ANOSCOPY W/BX SINGLE/MULTIPLE
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
20300076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.92 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$462.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$606.90
|
| Rate for Payer: First Health Commercial |
$642.60
|
| Rate for Payer: First Health Workers Compensation |
$275.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$642.60
|
| Rate for Payer: GEHA Commercial |
$571.20
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$642.60
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$471.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$649.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$499.80
|
| Rate for Payer: One Health Plan PPO/POS |
$642.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$544.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$471.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$678.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$535.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$471.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$285.60
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$194.92
|
|
|
ANOSCOPY W/BX SINGLE/MULTIPLE
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
6146606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$2,239.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$583.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$462.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,119.58
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$91.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: GEHA Medicare |
$1,119.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$1,231.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,119.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,880.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$471.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,119.58
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.29
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$544.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$471.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,119.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,239.16
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,097.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$471.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,119.58
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Medicare |
$951.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,343.50
|
| Rate for Payer: Zelis Worker's Compensation |
$64.70
|
|
|
ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE TECHNIQUE
|
Facility
|
OP
|
$1,731.42
|
|
|
Service Code
|
CPT 46611
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$735.85 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
|
|
ANOSCOPY W/RMVL FOREIGN BODY
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
21600164
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$642.60
|
| Rate for Payer: First Health Commercial |
$680.40
|
| Rate for Payer: First Health Workers Compensation |
$291.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$680.40
|
| Rate for Payer: GEHA Commercial |
$529.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$680.40
|
| Rate for Payer: Multiplan All |
$687.96
|
| Rate for Payer: OMNI Networks Commercial |
$529.20
|
| Rate for Payer: One Health Plan PPO/POS |
$680.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$718.20
|
| Rate for Payer: Three Rivers Provider Network All |
$567.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$703.08
|
| Rate for Payer: Zelis Auto |
$302.40
|
| Rate for Payer: Zelis Worker's Compensation |
$206.39
|
|
|
ANOSCOPY W/RMVL FOREIGN BODY
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
6146608
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.07 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$177.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
ANOSCOPY W/RMVL FOREIGN BODY
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
6146608
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.07 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$202.40
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
ANOSCOPY W/RMVL FOREIGN BODY
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
21600164
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$453.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$934.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$740.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$642.60
|
| Rate for Payer: First Health Commercial |
$680.40
|
| Rate for Payer: First Health Workers Compensation |
$291.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$680.40
|
| Rate for Payer: GEHA Commercial |
$604.80
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$680.40
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$755.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$687.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$529.20
|
| Rate for Payer: One Health Plan PPO/POS |
$680.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$872.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$755.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$718.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$567.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$755.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$703.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$302.40
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$206.39
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYS
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
23500063
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$954.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYS
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
23500063
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$818.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$1,091.20
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYS
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
6157240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$954.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYS
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
6157240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$818.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$1,091.20
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
anticarbamylated protein REF520311
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$131.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
anticarbamylated protein REF520311
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2200843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
anticardiolipin, IgA quant REF161836
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22990881
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.90 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$49.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Worker's Compensation |
$34.90
|
|
|
anticardiolipin, IgA quant REF161836
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22990881
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$49.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$147.20
|
| Rate for Payer: GEHA Medicare |
$25.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Humana ChoiceCare |
$28.00
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.45
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.27
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.90
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$156.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.45
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Medicare |
$21.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.54
|
| Rate for Payer: Zelis Worker's Compensation |
$34.90
|
|
|
anticardiolipin, IgG quant REF161810
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22990882
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.90 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$49.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Worker's Compensation |
$34.90
|
|
|
anticardiolipin, IgG quant REF161810
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22990882
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$49.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$147.20
|
| Rate for Payer: GEHA Medicare |
$25.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Humana ChoiceCare |
$28.00
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.45
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.27
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.90
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$156.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.45
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Medicare |
$21.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.54
|
| Rate for Payer: Zelis Worker's Compensation |
$34.90
|
|
|
anticardiolipin, IgM quant REF161828
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22990883
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.90 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$49.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Worker's Compensation |
$34.90
|
|
|
anticardiolipin, IgM quant REF161828
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
22990883
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$49.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$147.20
|
| Rate for Payer: GEHA Medicare |
$25.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Humana ChoiceCare |
$28.00
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.45
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.27
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.90
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.94
|
| Rate for Payer: United Healthcare Commercial |
$156.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.45
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Medicare |
$21.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.54
|
| Rate for Payer: Zelis Worker's Compensation |
$34.90
|
|
|
anticentromere B abs REF164814
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2299088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
anticentromere B abs REF164814
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2299088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
|
anti centromer REF 520065
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2232296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$29.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$17.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$19.72
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.93
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.86
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.93
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$15.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.52
|
| Rate for Payer: Zelis Worker's Compensation |
$20.72
|
|
