|
PHOSPHATIDYLERINE AB IGA PAN REF
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2200073
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGG PAN REF
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2200072
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$16.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.07
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.32
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.14
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.07
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$13.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.28
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGG PAN REF
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2200072
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGG PAN REF
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2300021
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGG PAN REF
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2300021
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$16.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.07
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.32
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.14
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.07
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$13.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.28
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGM PAN REF
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2200074
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGM PAN REF
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2200074
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$16.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.07
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.32
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.14
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.07
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$13.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.28
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGM PAN REF
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2300023
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$16.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$17.68
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$27.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.07
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.32
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$32.14
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$139.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.07
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$13.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.28
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
PHOSPHATIDYLERINE AB IGM PAN REF
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2300023
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$39.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.66
|
|
|
phosphatidylethanol (peth) REF791584
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
2200846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$39.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.00
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$127.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
phosphatidylethanol (peth) REF791584
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
2200846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$57.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$105.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.95
|
|
|
PHOSPHORS UA POP
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2299383
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$9.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$51.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.75
|
|
|
PHOSPHORS UA POP
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2299383
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$9.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$5.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$6.36
|
| Rate for Payer: Humana Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.78
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.83
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.56
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.66
|
| Rate for Payer: United Healthcare Commercial |
$62.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.78
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$4.91
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.94
|
| Rate for Payer: Zelis Worker's Compensation |
$6.75
|
|
|
PHOSPHORUS (Vitros)
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
2232208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$74.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
PHOSPHORUS (Vitros)
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
2232208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.74
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$84.80
|
| Rate for Payer: GEHA Medicare |
$4.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Humana ChoiceCare |
$5.21
|
| Rate for Payer: Humana Medicare Advantage |
$4.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.74
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.06
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.48
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$90.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.74
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Medicare |
$4.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.69
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
PH TEST
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
NDC 00003052650
|
| Hospital Charge Code |
3300704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
PH TEST
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
NDC 00003052650
|
| Hospital Charge Code |
3300704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$42.64
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$98.40
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$144.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
PHYS CERT MCR-COVR HOM HLTH SRVC
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT G0180
|
| Hospital Charge Code |
8500180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$248.75 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Humana ChoiceCare |
$258.70
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$597.00
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$875.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$497.50
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
PHYS CERT MCR-COVR HOM HLTH SRVC
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT G0180
|
| Hospital Charge Code |
8500180
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
PHYSICAL THERAPY EVALUATION MOD COMPLEX
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
1999217
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.41
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: First Health Workers Compensation |
$188.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$390.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| Rate for Payer: Humana ChoiceCare |
$126.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.84
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.80
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$429.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: Zelis Auto |
$195.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$244.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.22
|
|
|
PHYSICAL THERAPY EVALUATION MOD COMPLEX
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
20399218
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.41
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$190.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$204.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Humana ChoiceCare |
$66.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.84
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$153.00
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$216.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.50
|
| Rate for Payer: Zelis Worker's Compensation |
$134.93
|
|
|
PHYSICAL THERAPY EVALUATION MOD COMPLEX
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
1999217
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: First Health Workers Compensation |
$188.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$341.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: Zelis Auto |
$195.20
|
| Rate for Payer: Zelis Worker's Compensation |
$133.22
|
|
|
PHYSICAL THERAPY EVALUATION MOD COMPLEX
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
20399218
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$178.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
PHYSICIAN PHONE CONSULTATION
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
21600358
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
PHYSICIAN PHONE CONSULTATION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 99442
|
| Hospital Charge Code |
21600357
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
