|
INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$413.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Humana ChoiceCare |
$134.42
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$310.20
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$454.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$129.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$258.50
|
|
|
INTRODUCER SILOUETTE PEEL-AWAY
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
7002412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$413.60
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$439.45
|
| Rate for Payer: First Health Commercial |
$465.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$465.30
|
| Rate for Payer: GEHA Commercial |
$361.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$465.30
|
| Rate for Payer: Multiplan All |
$470.47
|
| Rate for Payer: OMNI Networks Commercial |
$361.90
|
| Rate for Payer: One Health Plan PPO/POS |
$465.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$491.15
|
| Rate for Payer: Three Rivers Provider Network All |
$387.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$480.81
|
| Rate for Payer: Zelis Auto |
$206.80
|
|
|
INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
21600134
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
21600134
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
8136000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
8136000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$117.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$244.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Humana ChoiceCare |
$79.30
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.00
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$268.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$152.50
|
| Rate for Payer: Zelis Worker's Compensation |
$83.27
|
|
|
INTRO GASTROINTESTINAL TUBE
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
6144500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$510.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$65.45
|
| Rate for Payer: First Health Commercial |
$69.30
|
| Rate for Payer: First Health Workers Compensation |
$29.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$69.30
|
| Rate for Payer: GEHA Commercial |
$61.60
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$69.30
|
| 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 |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$70.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$53.90
|
| Rate for Payer: One Health Plan PPO/POS |
$69.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$601.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$520.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$73.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$57.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$71.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$30.80
|
| 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 |
$21.02
|
|
|
INTRO GASTROINTESTINAL TUBE
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
6144500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$65.45
|
| Rate for Payer: First Health Commercial |
$69.30
|
| Rate for Payer: First Health Workers Compensation |
$29.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$69.30
|
| Rate for Payer: GEHA Commercial |
$53.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$69.30
|
| Rate for Payer: Multiplan All |
$70.07
|
| Rate for Payer: OMNI Networks Commercial |
$53.90
|
| Rate for Payer: One Health Plan PPO/POS |
$69.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$73.15
|
| Rate for Payer: Three Rivers Provider Network All |
$57.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$71.61
|
| Rate for Payer: Zelis Auto |
$30.80
|
| Rate for Payer: Zelis Worker's Compensation |
$21.02
|
|
|
INTRO OF NEEDLE OR INTRACATH UPR/LXT ART
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
6136140
|
|
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
|
|
|
INTRO OF NEEDLE OR INTRACATH UPR/LXT ART
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
6136140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Great West Healthcare (Cigna) Commercial |
$263.70
|
| Rate for Payer: Humana ChoiceCare |
$76.18
|
| Rate for Payer: Multiplan All |
$266.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$257.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$272.49
|
| Rate for Payer: Zelis Auto |
$117.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.50
|
| Rate for Payer: Zelis Worker's Compensation |
$79.99
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4000222
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$385.48 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cigna Commercial |
$1,200.20
|
| Rate for Payer: First Health Commercial |
$1,270.80
|
| Rate for Payer: First Health Workers Compensation |
$545.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,270.80
|
| Rate for Payer: GEHA Commercial |
$988.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,270.80
|
| Rate for Payer: Multiplan All |
$1,284.92
|
| Rate for Payer: OMNI Networks Commercial |
$988.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,270.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,341.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,313.16
|
| Rate for Payer: Zelis Auto |
$564.80
|
| Rate for Payer: Zelis Worker's Compensation |
$385.48
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8150096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.09 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$847.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cigna Commercial |
$1,200.20
|
| Rate for Payer: First Health Commercial |
$1,270.80
|
| Rate for Payer: First Health Workers Compensation |
$545.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,270.80
|
| Rate for Payer: GEHA Commercial |
$1,129.60
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,270.80
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$157.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$1,284.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$988.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,270.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$181.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$157.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,341.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$157.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,313.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$564.80
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$385.48
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
IP
|
$1,396.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
6131500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.11 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$1,186.60
|
| Rate for Payer: First Health Commercial |
$1,256.40
|
| Rate for Payer: First Health Workers Compensation |
$539.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,256.40
|
| Rate for Payer: GEHA Commercial |
$977.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,256.40
|
| Rate for Payer: Multiplan All |
$1,270.36
|
| Rate for Payer: OMNI Networks Commercial |
$977.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,256.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,326.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,298.28
|
| Rate for Payer: Zelis Auto |
$558.40
|
| Rate for Payer: Zelis Worker's Compensation |
$381.11
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
1000025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.48 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cigna Commercial |
$1,200.20
|
| Rate for Payer: First Health Commercial |
$1,270.80
|
| Rate for Payer: First Health Workers Compensation |
$545.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,270.80
|
| Rate for Payer: GEHA Commercial |
$988.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,270.80
|
| Rate for Payer: Multiplan All |
$1,284.92
|
| Rate for Payer: OMNI Networks Commercial |
$988.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,270.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,341.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,313.16
|
| Rate for Payer: Zelis Auto |
$564.80
|
| Rate for Payer: Zelis Worker's Compensation |
$385.48
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
6100004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$154.09 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$847.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cigna Commercial |
$1,200.20
|
| Rate for Payer: First Health Commercial |
$1,270.80
|
| Rate for Payer: First Health Workers Compensation |
$283.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,270.80
|
| Rate for Payer: GEHA Commercial |
$1,129.60
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,270.80
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$157.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$1,284.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$988.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,270.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$181.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$157.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,341.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$157.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,313.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$564.80
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$200.66
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
4000222
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$154.09 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$847.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cigna Commercial |
$1,200.20
|
| Rate for Payer: First Health Commercial |
$1,270.80
|
| Rate for Payer: First Health Workers Compensation |
$545.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,270.80
|
| Rate for Payer: GEHA Commercial |
$1,129.60
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,270.80
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$157.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$1,284.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$988.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,270.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$181.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$157.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,341.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$157.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,313.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$564.80
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$385.48
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8150096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.48 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cigna Commercial |
$1,200.20
|
| Rate for Payer: First Health Commercial |
$1,270.80
|
| Rate for Payer: First Health Workers Compensation |
$545.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,270.80
|
| Rate for Payer: GEHA Commercial |
$988.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,270.80
|
| Rate for Payer: Multiplan All |
$1,284.92
|
| Rate for Payer: OMNI Networks Commercial |
$988.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,270.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,341.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,313.16
|
| Rate for Payer: Zelis Auto |
$564.80
|
| Rate for Payer: Zelis Worker's Compensation |
$385.48
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
OP
|
$1,396.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
6131500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.09 |
| Max. Negotiated Rate |
$1,326.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$837.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cigna Commercial |
$1,186.60
|
| Rate for Payer: First Health Commercial |
$1,256.40
|
| Rate for Payer: First Health Workers Compensation |
$539.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,256.40
|
| Rate for Payer: GEHA Commercial |
$1,116.80
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,256.40
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$157.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$1,270.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$977.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,256.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$181.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$157.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,326.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,047.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$157.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,298.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$558.40
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$381.11
|
|
|
INTUBATION ENDOTRACHEAL EMERGENCY PROCED
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
6100004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.48 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Cash Price |
$847.20
|
| Rate for Payer: Cigna Commercial |
$1,200.20
|
| Rate for Payer: First Health Commercial |
$1,270.80
|
| Rate for Payer: First Health Workers Compensation |
$545.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,270.80
|
| Rate for Payer: GEHA Commercial |
$988.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,270.80
|
| Rate for Payer: Multiplan All |
$1,284.92
|
| Rate for Payer: OMNI Networks Commercial |
$988.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,270.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,341.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,059.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,313.16
|
| Rate for Payer: Zelis Auto |
$564.80
|
| Rate for Payer: Zelis Worker's Compensation |
$385.48
|
|
|
INVEGA SUSTENNA 156MG INJ.
|
Facility
|
IP
|
$5,136.00
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
3305031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,402.13 |
| Max. Negotiated Rate |
$4,879.20 |
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cigna Commercial |
$4,365.60
|
| Rate for Payer: First Health Commercial |
$4,622.40
|
| Rate for Payer: First Health Workers Compensation |
$1,983.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,622.40
|
| Rate for Payer: GEHA Commercial |
$3,595.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,622.40
|
| Rate for Payer: Multiplan All |
$4,673.76
|
| Rate for Payer: OMNI Networks Commercial |
$3,595.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,622.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,879.20
|
| Rate for Payer: Three Rivers Provider Network All |
$3,852.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,776.48
|
| Rate for Payer: Zelis Auto |
$2,054.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,402.13
|
|
|
INVEGA SUSTENNA 156MG INJ.
|
Facility
|
OP
|
$5,136.00
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
3305031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$4,879.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,081.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.11
|
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cigna Commercial |
$4,365.60
|
| Rate for Payer: First Health Commercial |
$4,622.40
|
| Rate for Payer: First Health Workers Compensation |
$1,983.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,622.40
|
| Rate for Payer: GEHA Commercial |
$16.62
|
| Rate for Payer: GEHA Medicare |
$15.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,622.40
|
| Rate for Payer: Humana ChoiceCare |
$16.62
|
| Rate for Payer: Humana Medicare Advantage |
$15.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.11
|
| Rate for Payer: Multiplan All |
$4,673.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.69
|
| Rate for Payer: OMNI Networks Commercial |
$3,595.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,622.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,879.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,852.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,776.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.11
|
| Rate for Payer: Zelis Auto |
$2,054.40
|
| Rate for Payer: Zelis Medicare |
$12.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.13
|
| Rate for Payer: Zelis Worker's Compensation |
$1,402.13
|
|
|
INVEGA SUSTENNA 234MG INJ
|
Facility
|
IP
|
$7,406.00
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
3305011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,021.84 |
| Max. Negotiated Rate |
$7,035.70 |
| Rate for Payer: Cash Price |
$4,443.60
|
| Rate for Payer: Cigna Commercial |
$6,295.10
|
| Rate for Payer: First Health Commercial |
$6,665.40
|
| Rate for Payer: First Health Workers Compensation |
$2,859.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,665.40
|
| Rate for Payer: GEHA Commercial |
$5,184.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,665.40
|
| Rate for Payer: Multiplan All |
$6,739.46
|
| Rate for Payer: OMNI Networks Commercial |
$5,184.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,665.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,035.70
|
| Rate for Payer: Three Rivers Provider Network All |
$5,554.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,887.58
|
| Rate for Payer: Zelis Auto |
$2,962.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,021.84
|
|
|
INVEGA SUSTENNA 234MG INJ
|
Facility
|
OP
|
$7,406.00
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
3305011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$7,035.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,443.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.11
|
| Rate for Payer: Cash Price |
$4,443.60
|
| Rate for Payer: Cash Price |
$4,443.60
|
| Rate for Payer: Cigna Commercial |
$6,295.10
|
| Rate for Payer: First Health Commercial |
$6,665.40
|
| Rate for Payer: First Health Workers Compensation |
$2,859.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,665.40
|
| Rate for Payer: GEHA Commercial |
$16.62
|
| Rate for Payer: GEHA Medicare |
$15.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,665.40
|
| Rate for Payer: Humana ChoiceCare |
$16.62
|
| Rate for Payer: Humana Medicare Advantage |
$15.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.11
|
| Rate for Payer: Multiplan All |
$6,739.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.69
|
| Rate for Payer: OMNI Networks Commercial |
$5,184.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,665.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,035.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.22
|
| Rate for Payer: Three Rivers Provider Network All |
$5,554.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.81
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,887.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.11
|
| Rate for Payer: Zelis Auto |
$2,962.40
|
| Rate for Payer: Zelis Medicare |
$12.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.13
|
| Rate for Payer: Zelis Worker's Compensation |
$2,021.84
|
|
|
IO ANALYSIS GAST N-STIM INIT
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 95980
|
| Hospital Charge Code |
6195980
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Humana ChoiceCare |
$38.22
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$88.20
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$129.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$73.50
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
|
IO ANALYSIS GAST N-STIM INIT
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 95980
|
| Hospital Charge Code |
6195980
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$124.95
|
| Rate for Payer: First Health Commercial |
$132.30
|
| Rate for Payer: First Health Workers Compensation |
$56.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$132.30
|
| Rate for Payer: GEHA Commercial |
$102.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$132.30
|
| Rate for Payer: Multiplan All |
$133.77
|
| Rate for Payer: OMNI Networks Commercial |
$102.90
|
| Rate for Payer: One Health Plan PPO/POS |
$132.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$139.65
|
| Rate for Payer: Three Rivers Provider Network All |
$110.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$136.71
|
| Rate for Payer: Zelis Auto |
$58.80
|
| Rate for Payer: Zelis Worker's Compensation |
$40.13
|
|
